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Wilson EJ, Strait AV, Fricka KB, Hamilton WG, Sershon RA. Outcomes Following Intraoperative Calcar Fractures During Cementless Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00137-2. [PMID: 38401616 DOI: 10.1016/j.arth.2024.02.039] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Intraoperative calcar fractures (IOCFs) are an established complication of cementless total hip arthroplasty (THA). Prompt recognition and management may prevent subsequent postoperative complications. This study aimed to evaluate the outcomes and revision rates of THAs with IOCFs identified and managed intraoperatively. METHODS There were 11,438 primary cementless THAs performed at a single institution from 2009 to 2022. Prospectively collected data on cases with an IOCF was compared to cases without the complication. The fracture group had a lower body mass index (26.9 versus 28.9 kg/m2; P = .01). Patient age, sex, and mean follow-up (3.2 (0 to 12.8) versus 3.5 years (0 to 14); P = .45) were similar between groups. RESULTS An IOCF occurred in 62 of 11,438 (0.54%) cases. The THAs done via a direct anterior approach experienced the lowest rate of fractures (31 of 7,505, 0.4%) compared to postero-lateral (27 of 3,759, 0.7%; P = .03) and lateral (4 of 165, 2.4%; P < .01) approaches. Of the IOCFs, 48 of 62 (77%) were managed with cerclage cabling, 4 of 62 (6.5%) with intraoperative stem design change and cabling, 4 of 62 (6.5%) with restricted weight-bearing, and 6 of 62 (9.7%) with no modification to the standard postoperative protocol. The IOCF group experienced one case of postoperative component subsidence. No subjects in the IOCF cohort required revision, and rates were similar between groups (0 of 62, 0% versus 215 of 11,376, 1.9%; P = .63). Postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement scores were comparable (85.7 versus 86.4; P = .80). CONCLUSIONS Cementless THA complicated by IOCF had similar postoperative revision rates and patient-reported outcome measures at early follow-up when compared to patients not experiencing this complication. Surgeons may use these data to provide postoperative counseling on expectations and outcomes following these rare intraoperative events.
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Affiliation(s)
- Eric J Wilson
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | | | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
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Pina L, Smith B, Smith L, Wood GC, Horsley R, Falvo A, Still C, Petrick A, Obradovic V, Parker DM. Rates of Recurrent Marginal Ulcer in Gastric Bypass Patients Undergoing Revisional Surgery. Am Surg 2023; 89:5801-5805. [PMID: 37167426 DOI: 10.1177/00031348231175134] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION The rate of marginal ulcer (MU) following primary Roux-en-Y Gastric Bypass (RYGB) is approximately .6-16%. Few studies have evaluated recurrence rates following surgical revision for MU. The primary aim of this study was to determine the rate of MU recurrence following revision. The secondary aim was to evaluate the impact of truncal vagotomy (TV) on the recurrence rates and analyze potential risk factors associated with the recurrence of MU after revision. METHODS We conducted a retrospective cohort study examining data at a single tertiary academic medical center. Adult patients with a history of RYGB who underwent gastrojejunostomy revision for recurrent MU between the years of 2003-2020 were included. We sought to determine our overall rate of MU following revision, with and without TV. Additionally, we examined the association of risk factors with MU recurrence. Fisher's exact test was used to determine the statistical significance of recurrence rates between the groups. RESULTS We included 90 patients in the study. The overall recurrence rate for MU was 16.7%. Of the 90 patients, 35 (35.4%) patients underwent TV at the time of revision. The recurrence rate of MU after GJ revision with TV was 14.3% in comparison to those without TV, 18.2% (P = .775). Smoking, steroid, alcohol use, history of cardiac surgery/intervention, and helicobacter pylori were not significantly associated with recurrent MU following revision. CONCLUSIONS The rate of recurrence after revision for MU is high. Adding TV trended towards decreased MU recurrence after revisional surgery, however not significant. Larger studies are needed to evaluate risk factors associated with recurrent MU after revision.
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Affiliation(s)
- Luis Pina
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - Benjamin Smith
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - Lynzi Smith
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - G Craig Wood
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - Ryan Horsley
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - Alexandra Falvo
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - Christopher Still
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - Anthony Petrick
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - Vladan Obradovic
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
| | - David M Parker
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, PA, USA
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Mirza SZ, Zhang Y, Do HT, Mehta B, Goodman SM, Bass AR. Black Patients are More Likely to Undergo Early Revision Total Knee Arthroplasty in a Matched Cohort Regardless of Surgeon Experience. J Arthroplasty 2023; 38:2226-2231.e14. [PMID: 37295621 DOI: 10.1016/j.arth.2023.05.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/07/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Black patients are at an increased risk of aseptic revision total knee arthroplasty (TKA) when compared to White patients. The goal of this study was to determine whether racial disparities in revision TKA risk are related to surgeon characteristics. METHODS This was an observational cohort study. We used inpatient administrative data to identify Black patients who underwent unilateral primary TKA in New York State. There were 21,948 Black patients who were matched 1:1 to White patients on age, sex, ethnicity, and insurance type. The primary outcome was aseptic revision TKA within 2 years of primary TKA. We calculated annual surgeon TKA volume and identified surgeon characteristics such as training in North America, board certification, and years of experience. RESULTS Black patients had a higher odds of aseptic revision TKA (odds ratio (OR) 1.32, 95% CI 1.12-1.54, P < .001) and were disproportionately cared for by low volume surgeons (≤12 TKA/year). The relationship between low volume surgeons and risk of aseptic revision was not statistically significant (OR 1.24, 95% CI 0.72-2.11, P = .436). The adjusted odds ratio (aOR) for aseptic revision TKA in Black versus White patients varied across surgeon/hospital TKA volume category pairs, with the greatest aOR when TKA were performed by the highest volume surgeons at the highest volume hospitals (aOR 2.8, 95% CI 0.98- 8.09, P = .055). CONCLUSION Black patients were more likely to undergo aseptic TKA revision than matched White patients. This disparity was not explained by surgeon characteristics.
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Affiliation(s)
- Serene Z Mirza
- Touro College of Osteopathic Medicine, New York, New York
| | - Yi Zhang
- Department of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Huong T Do
- Department of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Bella Mehta
- Department of Rheumatology, Hospital for Special Surgery, New York, New York; Department of Rheumatology, Weill Cornell Medicine, New York, New York
| | - Susan M Goodman
- Department of Rheumatology, Hospital for Special Surgery, New York, New York; Department of Rheumatology, Weill Cornell Medicine, New York, New York
| | - Anne R Bass
- Department of Rheumatology, Hospital for Special Surgery, New York, New York; Department of Rheumatology, Weill Cornell Medicine, New York, New York
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Papalia AG, Kingery MT, Romeo PV, Simcox T, Lin CC, Anil U, Zuckerman JD, Virk MS. Inpatient charges, complication, and revision rates for shoulder arthroplasty in Parkinson disease: a regional database study. J Shoulder Elbow Surg 2023; 32:2043-2050. [PMID: 37224916 DOI: 10.1016/j.jse.2023.04.003] [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: 02/07/2023] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Parkinson disease (PD) is an established risk factor for higher rates of complications and revision surgery following shoulder arthroplasty, yet the economic burden of PD remains to be elucidated. The purpose of this study is to compare rates of complication and revisions as well as inpatient charges for shoulder arthroplasty procedures between PD and non-PD patients using an all-payer statewide database. METHODS Patients undergoing primary shoulder arthroplasty from 2010 to 2020 were identified from the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database. Study groups were assigned based on concomitant diagnosis of PD at the time of index procedure. Baseline demographics, inpatient data, and medical comorbidities were collected. Primary outcomes measured were accommodation, ancillary, and total inpatient charges. Secondary outcomes included postoperative complication and reoperation rates. Logistic regression was performed to evaluate effect of PD on shoulder arthroplasty revision and complication rates. All statistical analysis was performed using R. RESULTS A total of 39,011 patients (429 PD vs. 38,582 non-PD) underwent 43,432 primary shoulder arthroplasties (477 PD vs. 42,955 non-PD) with mean follow-up duration of 2.9 ± 2.8 years. The PD cohort was older (72.3 ± 8.0 vs. 68.6 ± 10.4 years, P < .001), with greater male composition (50.8% vs. 43.0%, P = .001), and higher mean Elixhauser scores (1.0 ± 4.6 vs. 7.2 ± 4.3, P < .001). The PD cohort had significantly greater accommodation charges ($10,967 vs. $7,661, P < .001) and total inpatient charges ($62,000 vs. $56,000, P < .001). PD patients had significantly higher rates of revision surgery (7.7% vs. 4.2%, P = .002) and complications (14.1% vs. 10.5%, P = .040), as well as significantly higher incidences of readmission at 3 and 12 months postoperatively. After controlling for age and baseline comorbidities, PD patients had 1.64 times greater odds of reoperation compared to non-PD patients (95% CI 1.10, 2.37; P = .012) and a hazard ratio of 1.54 for reoperation when evaluating revision-free survival following primary shoulder arthroplasty (95% CI 1.07, 2.20; P = .019). CONCLUSIONS PD confers a longer length of stay, higher rates of postoperative complications and revisions, and greater inpatient charges in patients undergoing TSA. Knowledge of the associated risks and resource requirements of this population will aid surgeons in their decision making as they continue to provide care to a growing number of patients affected by PD.
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Affiliation(s)
- Aidan G Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew T Kingery
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Trevor Simcox
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Charles C Lin
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Utkarsh Anil
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
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Bhatt FR, Orosz LD, Tewari A, Boyd D, Roy R, Good CR, Schuler TC, Haines CM, Jazini E. Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws. Global Spine J 2023; 13:2047-2052. [PMID: 35000409 PMCID: PMC10556900 DOI: 10.1177/21925682211069321] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES In spine surgery, accurate screw guidance is critical to achieving satisfactory fixation. Augmented reality (AR) is a novel technology to assist in screw placement and has shown promising results in early studies. This study aims to provide our early experience evaluating safety and efficacy with an Food and Drug Administration-approved head-mounted (head-mounted device augmented reality (HMD-AR)) device. METHODS Consecutive adult patients undergoing AR-assisted thoracolumbar fusion between October 2020 and August 2021 with 2 -week follow-up were included. Preoperative, intraoperative, and postoperative data were collected to include demographics, complications, revision surgeries, and AR performance. Intraoperative 3D imaging was used to assess screw accuracy using the Gertzbein-Robbins (G-R) grading scale. RESULTS Thirty-two patients (40.6% male) were included with a total of 222 screws executed using HMD-AR. Intraoperatively, 4 (1.8%) were deemed misplaced and revised using AR or freehand. The remaining 218 (98.2%) screws were placed accurately. There were no intraoperative adverse events or complications, and AR was not abandoned in any case. Of the 208 AR-placed screws with 3D imaging confirmation, 97.1% were considered clinically accurate (91.8% Grade A, 5.3% Grade B). There were no early postoperative surgical complications or revision surgeries during the 2 -week follow-up. CONCLUSIONS This early experience study reports an overall G-R accuracy of 97.1% across 218 AR-guided screws with no intra or early postoperative complications. This shows that HMD-AR-assisted spine surgery is a safe and accurate tool for pedicle, cortical, and pelvic fixation. Larger studies are needed to continue to support this compelling evolution in spine surgery.
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Affiliation(s)
| | | | - Anant Tewari
- National Spine Health Foundation, Reston, VA, USA
| | - David Boyd
- Reston Radiology Consultants, Reston, VA, USA
| | - Rita Roy
- National Spine Health Foundation, Reston, VA, USA
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Abstract
The current article summarizes recent changes in nomenclature for fungi of medical importance published in the years 2020 to 2021, including new species and revised names for existing ones. Many of the revised names have been widely adopted without further discussion. However, those that concern common pathogens of humans may take longer to achieve general usage, with new and current names reported together to engender increasing familiarity with the correct taxonomic classification.
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Affiliation(s)
- Andrew M. Borman
- UK National Mycology Reference Laboratory, United Kingdom Health Security Agency South-West, Bristol, United Kingdom
- Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter, United Kingdom
| | - Elizabeth M. Johnson
- UK National Mycology Reference Laboratory, United Kingdom Health Security Agency South-West, Bristol, United Kingdom
- Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter, United Kingdom
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7
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Kuijpers MFL, Hannink G, van Steenbergen LN, Schreurs BW. A significant change towards cemented fixation in revision total hip arthroplasty in patients younger than 55 years in the Netherlands: results of an observational cohort study in the Dutch Arthroplasty Register in 28,516 primary hip replacements and 1285 revision procedures. Hip Int 2023; 33:288-297. [PMID: 34102901 PMCID: PMC9978863 DOI: 10.1177/11207000211020002] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Worldwide, the majority of total hip arthroplasties (THAs) placed in patients <55 years are uncemented. However, little is known about the preferred method of fixation in revision hip arthroplasty in young patients. The aim of this study was to assess potential differences in the method of fixation used between primary and revision THA in young patients using data from the Dutch Arthroplasty Register. METHODS All primary THA placed in patients younger than 55 years, registered in the LROI between 2007 and 2019 were included n = 28,516). Kaplan-Meier survival analyses were used to estimate the survival of primary THA by method of fixation. Additionally, survival of revision procedures that changed or did not change in method of fixation were estimated. McNemar's test was used to assess differences in the proportion of cemented and uncemented fixation between primary and revision THA. RESULTS In all acetabular revisions, the use of cemented fixation increased statistically significant with 39% (95% CI, 34-45, p < 0.001) from 23% in primary THA to 62% in revision procedures. In all femoral revisions, the increase of cemented fixation was also statistically significant with 25% (95% CI, 19-31, p < 0.001), from 11% in primary THA to 36% in revision surgery. For both revised acetabular and femoral components, we found no statistically significant difference in the 5-year survival between revision procedures that changed or did not change in method of fixation. CONCLUSIONS There was a significant change towards cemented fixation between primary and revision THA in young patients in the Netherlands, which was especially pronounced in acetabular revisions. No significant difference in short-term survival was found between revision procedures that changed or did not change in method of fixation. Long-term follow-up data are needed to evaluate the effect of this change in fixation method on the outcome of revision procedures in young patients.
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Affiliation(s)
- Martijn FL Kuijpers
- Department of Orthopaedics, Radboud
Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The
Netherlands,Martijn FL Kuijpers, Radboud University
Medical Centre, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud
Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The
Netherlands
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register (Landelijke
Registratie Orthopedische Implantaten), ‘s-Hertogenbosch, The Netherlands
| | - B Wim Schreurs
- Department of Orthopaedics, Radboud
Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The
Netherlands,Dutch Arthroplasty Register (Landelijke
Registratie Orthopedische Implantaten), ‘s-Hertogenbosch, The Netherlands
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Prkić A, Vermeulen NP, Kooistra BW, The B, van den Bekerom MPJ, Eygendaal D. Is there a relationship between surgical volume and outcome for total elbow arthroplasty? A systematic review. EFORT Open Rev 2023; 8:45-51. [PMID: 36705616 PMCID: PMC9969007 DOI: 10.1530/eor-22-0087] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Total elbow arthroplasty (TEA) is rarely performed compared to other arthroplasties. For many surgical procedures, literature shows better outcomes when they are performed by experienced surgeons and in so-called 'high-volume' hospitals. We systematically reviewed the literature on the relationship between surgical volume and outcomes following TEA. Methods A literature search was performed using the MEDLINE, EMBASE and CINAHL databases. The literature was systematically reviewed for original studies comparing TEA outcomes among hospitals or surgeons with different annual or career volumes. For each study, data were collected on study design, indications for TEA, number of included patients, implant types, cut-off values for volume, number and types of complications, revision rate and functional outcome measures. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Results Two studies, which included a combined 2301 TEAs, found that higher surgeon volumes were associated with lower revision rates. The examined complication rates did not differ between high- and low-volume surgeons. In one study, low-hospital volume is associated with an increased risk of revision compared to high-volume hospitals, but for other complication types, no difference was found. Conclusions Based on the results, the evidence suggests that high-volume centers have a lower revision rate in the long term. No minimum amount of procedures per year can be advised, as the included studies have different cut-off values between groups. As higher surgeon- and center-volume, (therefore presumably experience) appear to yield better outcomes, centralization of total elbow arthroplasty should be encouraged.
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Affiliation(s)
- A Prkić
- Department of Orthopedic Surgery, Upper Limb Section, Amphia Hospital, Breda, The Netherlands,Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands,Correspondence should be addressed to A Prkić;
| | - N P Vermeulen
- Department of Orthopedic Surgery, Upper Limb Section, Amphia Hospital, Breda, The Netherlands
| | - B W Kooistra
- Department of Orthopedic Surgery, Upper Limb Section, Amphia Hospital, Breda, The Netherlands,Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands,Department of Orthopedic Surgery, Medische Kliniek Velsen, Velsen-Noord, The Netherlands
| | - B The
- Department of Orthopedic Surgery, Upper Limb Section, Amphia Hospital, Breda, The Netherlands
| | - M P J van den Bekerom
- Department of Orthopedic Surgery, Medische Kliniek Velsen, Velsen-Noord, The Netherlands,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - D Eygendaal
- Department of Orthopedic Surgery and Sports Medicine, ErasmusMC, Rotterdam, The Netherlands
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Jayaram RH, Gillinov SM, Caruana DL, Kammien AJ, Joo PY, Rubin LE, Grauer JN. Total Hip Arthroplasty Imageless Navigation Does Not Reduce 90-Day Adverse Events or Five-Year Revisions in a Large National Cohort. J Arthroplasty 2022:S0883-5403(22)01088-9. [PMID: 36529197 DOI: 10.1016/j.arth.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Computer navigation is an increasingly utilized technology that is considered with total hip arthroplasty (THA). However, the evidence to support this practice is mixed. The current study leveraged a large national administrative database to compare 90-day adverse events as well as 5-year all-cause revision and dislocation rates following THA performed with and without imageless navigation. METHODS From 2010 to 2020, a large national database was queried for THA cases performed for osteoarthritis. Cases with or without imageless navigation were matched at 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) score. Ninety-day adverse events were assessed and compared with multivariate analyses. Five-year incidence of revision and dislocation were also assessed between cohorts. RESULTS Use of THA imageless navigation increased from 2010 (2.5% of cases) to 2020 (5.5% of cases; P < .001). After matching, 11,990 THA patients with navigation and 47,948 without navigation were identified. Overall, 90-day adverse events were observed in 7.0% of the population. Multivariate analysis controlling for age, sex, and ECI demonstrated a difference in only one 90-day adverse event; wound dehiscence, which had higher odds in the navigation group (odds ratio, 1.60, P < .001). At 5 years, revisions for the navigated group were higher (4.4 versus 3.6%: P = .006), while dislocations were not significantly different. CONCLUSION THA imageless navigation was not found to be associated with improved 90-day postoperative adverse events or differences in the 5-year rates of revision or dislocation. The current data were unable to identify clear advantages of this evolving technology for primary THA.
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Toivonen LA, Mäntymäki H, Häkkinen A, Kautiainen H, Neva MH. Postoperative Sagittal Balance Has Only a Limited Role in the Development of Adjacent Segment Disease After Lumbar Spine Fusion for Degenerative Lumbar Spine Disorders: A Subanalysis of the 10-year Follow-up Study. Spine (Phila Pa 1976) 2022; 47:1357-1361. [PMID: 35853095 PMCID: PMC9451944 DOI: 10.1097/brs.0000000000004400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/08/2021] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective additional analysis of a prospective follow-up study. OBJECTIVES We aimed to find out whether poor postoperative sagittal alignment increases revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) performed for degenerative lumbar spine disease. SUMMARY OF BACKGROUND DATA Revisions for ASD accumulate over time after LSF for degenerative lumbar spine disease. The etiology of ASD is considered multifactorial. Yet, the role of postoperative sagittal balance in this process remains controversial. MATERIALS AND METHODS A total of 215 consecutive patients who had undergone an elective LSF surgery for spinal stenosis with (80%) or without (20%) spondylolisthesis were analyzed. Spinal reoperations were collected from the hospital records. Preoperative and postoperative sagittal alignment were evaluated from standing radiographs. The risk of revisions for ASD was evaluated by Cox proportional hazards regression models. RESULTS We did not find the poor postoperative balance [pelvic incidence-lumbar lordosis (LL) >9°] to significantly increase the risk of revisions for ASD: crude hazard ratio (HR)=1.5 [95% confidence interval (CI): 0.8-2.7], adjusted (by age, sex, pelvic incidence, fusion length, and the level of the caudal end of fusion): HR=1.7 (95% CI: 0.9-3.3). We found higher LL outside the fusion segment (LL-segmental lordosis) to decrease the risk of revisions for ASD: HR=0.9 (95% CI: 0.9-1.0). CONCLUSION Poor sagittal balance has only a limited role as a risk factor for the revisions for ASD among patients with degenerative spinal disease. However, the risk for ASD might be the greatest among patients with reduced spinal mobility.
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Affiliation(s)
- Leevi A. Toivonen
- Department of Orthopaedics and Trauma, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Heikki Mäntymäki
- Department of Orthopaedics and Trauma, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Marko H. Neva
- Department of Orthopaedics and Trauma, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Tampere, Finland
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Tang A, Hojilla JC, Jackson JE, Rothenberg KA, Gologorsky RC, Stram DA, Mooney CM, Hernandez SL, Yokoo KM. Gender-Affirming Mastectomy Trends and Surgical Outcomes in Adolescents. Ann Plast Surg 2022; 88:S325-S331. [PMID: 36248210 PMCID: PMC9555285 DOI: 10.1097/sap.0000000000003135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Background There are over 150,000 transgender adolescents in the United States, yet research on outcomes following gender-affirming mastectomy in this age group is limited. We evaluated gender-affirming mastectomy incidence, as well as postoperative complications, including regret, in adolescents within our integrated health care system. Methods Gender-affirming mastectomies performed from January 1, 2013 - July 31, 2020 in adolescents 12-17 years of age at the time of referral were identified. The incidence of gender-affirming mastectomy was calculated by dividing the number of patients undergoing these procedures by the number of adolescents assigned female at birth ages 12-17 within our system at the beginning of each year and amount of follow-up time within that year. Demographic information, clinical characteristics (comorbidities, mental health history, testosterone use), surgical technique, and complications, including mention of regret, of patients who underwent surgery were summarized. Patients with and without complications were compared to evaluate for differences in demographic or clinical characteristics using chi-squared tests. Results The incidence of gender-affirming mastectomy increased 13-fold (3.7 to 47.7 per 100,000 person-years) during the study period. Of the 209 patients who underwent surgery, the median age at referral was 16 years (range 12-17) and the most common technique was double-incision (85%). For patients with greater than 1-year follow-up (n=137, 65.6%), at least one complication was found in 7.3% (n=10), which included hematoma (3.6%), infection (2.9%), hypertrophic scars requiring steroid injection (2.9%), seroma (0.7%), and suture granuloma (0.7%); 10.9 % underwent revision (n=15). There were no statistically significant differences in patient demographics and clinical characteristics between those with and without complications (p>0.05). Two patients (0.95%) had documented postoperative regret but neither underwent reversal surgery at follow-up of 3 and 7 years postoperatively. Conclusion Between 2013-2020, we observed a marked increase in gender-affirming mastectomies in adolescents. The prevalence of surgical complications was low and of over 200 adolescents who underwent surgery, only two expressed regret, neither of which underwent a reversal operation. Our study provides useful and positive guidance for adolescent patients, their families, and providers regarding favorable outcomes with gender-affirming mastectomy.
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Affiliation(s)
- Annie Tang
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - J Carlo Hojilla
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jordan E Jackson
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - Kara A Rothenberg
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - Rebecca C Gologorsky
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - Douglas A Stram
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Colin M Mooney
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - Stephanie L Hernandez
- Multispecialty Transition Department, Kaiser Permanente Northern California, Oakland, CA
| | - Karen M Yokoo
- Department of Plastic Surgery, Kaiser Permanente Northern California, Richmond, CA
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12
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Toivonen LA, Mäntymäki H, Häkkinen A, Kautiainen H, Neva MH. Isthmic Spondylolisthesis is Associated with Less Revisions for Adjacent Segment Disease After Lumbar Spine Fusion Than Degenerative Spinal Conditions: A 10-Year Follow-Up Study. Spine (Phila Pa 1976) 2022; 47:303-308. [PMID: 35068470 PMCID: PMC8772434 DOI: 10.1097/brs.0000000000004242] [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: 04/18/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, follow-up study. OBJECTIVE We aim to compare the rate of revisions for ASD after LSF surgery between patients with IS and DLSD. SUMMARY OF BACKGROUND DATA ASD is a major reason for late reoperations after LSF surgery. Several risk factors are linked to the progression of ASD, but the understanding of the underlying mechanisms is imperfect. If IS infrequently becomes complicated with ASD, it would emphasize the role of the ongoing degenerative process in spine in the development of ASD. METHODS 365 consecutive patients that underwent elective LSF surgery were followed up for an average of 9.7 years. Surgical indications were classified into 1) IS (n = 64), 2) DLSD (spinal stenosis with or without spondylolisthesis) (n = 222), and 3) other reasons (deformities, postoperative conditions after decompression surgery, posttraumatic conditions) (n = 79). All spinal reoperations were collected from hospital records. Rates of revisions for ASD were determined using Kaplan-Meier methods. RESULTS Altogether, 65 (17.8%) patients were reoperated for ASD. The incidences of revisions for ASD in subgroups were 1) 4.8% (95% CI: 1.6%-22.1%); 2) 20.5% (95% CI: 15.6%-26.7%); 3) 20.6% (95% CI: 12.9%-31.9%). After adjusting the groups by age, sex, fusion length, and the level of the caudal end of fusion, when comparing with IS group, the other groups had significantly higher hazard ratios (HR) for the revision for ASD [2) HR (95% CI) 3.92 (1.10-13.96), P = 0.035], [3) HR (95% CI) of 4.27 (1.11-15.54), P = 0.036]. CONCLUSION Among patients with IS, the incidence of revisions for ASD was less than a 4th of that with DLSD. Efforts to prevent the acceleration of the degenerative process at the adjacent level of fusion are most important with DLSD.Level of Evidence: 3.
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Affiliation(s)
- Leevi A. Toivonen
- Department of Orthopaedics and Trauma, University of Tampere, Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - Heikki Mäntymäki
- Department of Orthopaedics and Trauma, University of Tampere, Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Marko H. Neva
- Department of Orthopaedics and Trauma, University of Tampere, Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
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13
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Abstract
In this article, we critically review the changes made to the DSM-5 Text Revision published in 2022 regarding the diagnostic entity of Attention Deficit/Hyperactivity Disorder (ADHD). We structure our critique around three points. The first discusses the acknowledgment of ADHD as a neurodevelopmental disorder. The second examines the definition of ADHD provided in the updated edition of the manual. The third scrutinizes the changes in the diagnostic criteria for ADHD and assesses whether these changes make the diagnosis more accurate. We conclude that DSM's latest edition does not escape the logical and scientific pitfalls of its predecessor. DSM-5-TR keeps the faith in the neo-Kraepelinian paradigm by explicitly and implicitly cultivating the essentialist medical scientific metaphor of disorder, creating the illusion that it represents scientific progress that validates ADHD as a neurodevelopmental disorder.
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Affiliation(s)
| | - Juho Honkasilta
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
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14
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Campi S, Papalia GF, Esposito C, Albo E, Cannata F, Zampogna B, Papalia R, Denaro V. Unicompartmental Knee Replacement in Obese Patients: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:3594. [PMID: 34441889 DOI: 10.3390/jcm10163594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022] Open
Abstract
Thanks to modern surgical techniques and implants, traditional exclusion criteria for unicompartmental knee arthroplasty (UKA) are no longer considered contraindications. The aim of this study is to clarify the impact of obesity on functional outcomes and revision rates of UKA. We performed a comprehensive systematic review using PubMed–Medline, Google Scholar and Cochrane Central. Then, we extracted data related to body mass index (BMI), age and follow-up, functional outcome scores and rate of revisions (all-cause, aseptic and septic). Patients were stratified according to BMI into two groups: non-obese (BMI < 30) and obese (BMI ≥ 30). We identified 22 eligible studies, of which 13 were included in the meta-analysis. Patients with a BMI > 30 had a significantly higher likelihood for revision (p = 0.02), while the risk of septic revision was similar (p = 0.79). The clinical outcome measures showed a significant difference in favor of patients with a BMI < 30 (p < 0.0001). The improvements in Oxford Knee Score and Knee Society Score were significant in both obese and non-obese patients, although the latter showed inferior results. The results of this systematic review and meta-analysis show that BMI is not a contraindication to UKA. However, obese patients have a higher risk for aseptic failure and lower improvement in clinical scores compared to non-obese patients.
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15
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Goyal DKC, Divi SN, Bowles DR, Mujica VE, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Does Smoking Affect Short-Term Patient-Reported Outcomes After Lumbar Decompression? Global Spine J 2021; 11:727-732. [PMID: 32875911 PMCID: PMC8165909 DOI: 10.1177/2192568220925791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The goal of this study was to determine how smoking status influences patient-reported outcome measurements (PROMs) in patients undergoing lumbar decompression surgery. METHODS Patients undergoing lumbar decompression between 1 to 3 levels at a single-center, academic hospital were retrospectively identified. Patients <18 years old, and those undergoing surgery for infection, trauma, tumor, or revision, with less than 12 months of follow-up were excluded. Patients were divided into 3 groups: (1) never smokers (NSs); (2) current smokers (CSs); and (3) former smokers (FSs). PROMs analyzed included the Physical Component Score and Mental Component Score of the Short Form-12 Health Survey, the Oswestry Disability Index, and Visual Analogue Scale Back and Leg pain scores. One-way ANOVA was used to compare preoperative and postoperative scores between smoking groups, and multiple linear regression analysis was performed to determine whether smoking status predicted change in each outcome score, controlling for factors such as age, sex, body mass index, and other clinical variables. A P value <.05 was considered to be significant. RESULTS A total of 195 patients were included in the final cohort, with 121 (62.1%) patients in the NS group, 22 (11.3%) in the CS group, and 52 (26.6%) in the FS group. There were no significant differences between groups at baseline or postoperatively. Smoking status was also not a significant predictor of change in any outcome scores over time on multivariate analysis. CONCLUSION These results suggest that smoking status does not significantly affect short-term complications or outcomes in patients undergoing lumbar decompression surgery.
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Affiliation(s)
- Dhruv K. C. Goyal
- Thomas Jefferson University, Philadelphia, PA, USA,Dhruv K. C. Goyal, Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | | | | | | | | | - Mark F. Kurd
- Thomas Jefferson University, Philadelphia, PA, USA
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16
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Porschke F, Bockmeyer J, Nolte PC, Studier-Fischer S, Guehring T, Schnetzke M. More Adverse Events after Osteosyntheses Compared to Arthroplasty in Geriatric Proximal Humeral Fractures Involving Anatomical Neck. J Clin Med 2021; 10:jcm10050979. [PMID: 33801182 PMCID: PMC7957872 DOI: 10.3390/jcm10050979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022] Open
Abstract
The purpose of this study was to compare adverse events and clinical outcomes of geriatric proximal humerus fractures (PHF) involving the anatomical neck (type C according to AO classification) treated with open reduction and internal fixation (ORIF) using locking plate vs. arthroplasty. In this retrospective cohort study, geriatric patients (>64 years) who underwent operative treatment using ORIF or arthroplasty for type C PHFs were included. Complications, revisions and clinical outcomes using Constant Murley Score (CMS) and Disabilities of the Arm, Shoulder and Hand (DASH) Score were assessed and compared between groups. At a mean follow up of 2.7 ± 1.7 years, 59 patients (mean age 75.3 ± 5.5 years) were included. In 31 patients ORIF was performed and 29 patients underwent arthroplasty. Complications and revision surgeries were significantly more frequent after ORIF (32.6% vs. 7.1%, p = 0.023 and 29.0% vs. 7.1%, p = 0.045). In contrast, clinical outcomes showed no significant differences (DASH 39.9 ± 25.7 vs. 39.25 ± 24.5, p = 0.922; CMS 49.7 ± 29.2 vs. 49.4 ± 25.2, p = 0.731). ORIF of type C PHFs in geriatric patients results in significantly more complications and revision surgery when compared to arthroplasty. Therefore, osteosynthesis of geriatric intraarticular fractures of the proximal humerus must be critically evaluated.
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Affiliation(s)
- Felix Porschke
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany; (J.B.); (P.-C.N.); (S.S.-F.); (M.S.)
- Correspondence: ; Tel.: +49-6210-68100
| | - Julia Bockmeyer
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany; (J.B.); (P.-C.N.); (S.S.-F.); (M.S.)
| | - Philip-Christian Nolte
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany; (J.B.); (P.-C.N.); (S.S.-F.); (M.S.)
| | - Stefan Studier-Fischer
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany; (J.B.); (P.-C.N.); (S.S.-F.); (M.S.)
| | - Thorsten Guehring
- Department of Orthopedic Surgery, Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstraße 38, 70176 Stuttgart, Germany;
| | - Marc Schnetzke
- BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany; (J.B.); (P.-C.N.); (S.S.-F.); (M.S.)
- German Joint Center, Atos Clinic Heidelberg, Bismarckstraße 9-15, 69115 Heidelberg, Germany
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17
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Ardeljan AD, Polisetty TS, Palmer JR, Toma JJ, Grewal G, Roche MW. Pigmented Villonodular Synovitis of the Hip in Patients Undergoing Total Hip Arthroplasty: A Retrospective Case-Controlled Analysis. J Arthroplasty 2021; 36:1018-1022. [PMID: 32978024 DOI: 10.1016/j.arth.2020.08.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/28/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a condition affecting larger joints such as the hip and knee. Little is known regarding the impact of PVNS on total hip arthroplasty (THA). Therefore, the aim of this study is to determine if patients with PVNS of the hip undergoing primary THA experience greater (1) in-hospital lengths of stay (LOS); (2) complications; (3) readmission rates; and (4) costs. METHODS Patients undergoing primary THA for PVNS of the hip from the years 2005 to 2014 were identified using a nationwide claims registry. PVNS patients were matched to a control cohort in a 1:5 ratio by age, gender, and various comorbidities. The query yielded 7440 patients with (n = 1240) and without (n = 6200) PVNS of the hip undergoing primary THA. Endpoints analyzed included LOS, complications, readmission rates, and costs. Multivariate logistic regression was used to determine odds ratios (OR) of developing complications. Welch's t-tests were used to test for significance in LOS and cost between the cohorts. A P-value less than .001 was considered statistically significant. RESULTS PVNS patients had approximately 8% longer in-hospital LOS (3.8 vs 3.5 days, P = .0006). PVNS patients had greater odds of (OR 1.60, P < .0001) medical and (OR 1.81, P < .0001) implant-related complications. Furthermore, PVNS patients were found to have higher odds (OR 1.84, P < .0001) of 90-day readmissions. PVNS patients also incurred higher day of surgery ($13,119 vs $11,983, P < .0001) and 90-day costs ($17,169 vs $15,097, P < .0001). CONCLUSION Without controlling for global trends in LOS, complications, readmissions, or costs between 2005 and 2014, the findings of the study suggest that PVNS of the hip is associated with worse outcomes and higher costs following primary THA. The study is useful as orthopedic surgeons can use the study to educate patients of the complications which may occur following their hip surgery.
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Affiliation(s)
- Andrew D Ardeljan
- Nova Southeastern College of Osteopathic Medicine, Fort Lauderdale, FL; Department of Orthopaedic Research, Orthopaedic Research Institute, Fort Lauderdale, FL
| | - Teja S Polisetty
- Department of Orthopaedic Research, Orthopaedic Research Institute, Fort Lauderdale, FL; Harvard Medical School, Harvard University, Boston, MA
| | - Joseph R Palmer
- Department of Orthopaedic Surgery, Broward Health Medical Center, Fort Lauderdale, FL
| | - Justin J Toma
- Department of Orthopaedic Research, Orthopaedic Research Institute, Fort Lauderdale, FL
| | - Gagan Grewal
- Department of Orthopaedic Research, Orthopaedic Research Institute, Fort Lauderdale, FL
| | - Martin W Roche
- Department of Orthopaedic Research, Orthopaedic Research Institute, Fort Lauderdale, FL
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18
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Abstract
The current article summarizes recent changes in nomenclature for fungi of medical importance published in the years 2018 to 2019, including new species and revised names for existing ones. Many of the revised names have been widely adopted without further discussion. However, those that concern common pathogens of humans may take longer to achieve general usage, with new and current names reported together to engender increasing familiarity with the correct taxonomic classification.
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19
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Shapira J, Bheem R, Kyin C, Rosinsky PJ, Meghpara MB, Maldonado DR, Lall AC, Domb BG. Can Patient-Reported Outcomes Predict the Need for Secondary Surgeries After Hip Arthroscopy? Am J Sports Med 2021; 49:97-103. [PMID: 33259226 DOI: 10.1177/0363546520974374] [Citation(s) in RCA: 6] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) capture the postoperative period and reflect the patient's perspective of one's own recovery. However, it is unknown if PROs can reflect and predict the need for secondary surgeries after a primary hip arthroscopy. PURPOSE To examine if PROs at 3 months and 1 year after primary hip arthroscopy were correlated with future reoperations and determine the critical thresholds for significant PROs utilizing a multivariate logistic regression analysis and receiver operator characteristic (ROC) analysis. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data on consecutive patients who underwent primary hip arthroscopy between February 2008 and August 2018 was retrospectively reviewed. Patients were included for analysis if they had the following PROs preoperatively and at 3 months and 1 year postoperatively: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain. Patients were split into 2 groups: those who underwent secondary surgery and those who did not. Patient variables, intraoperative labral treatment, preoperative PROs, and postoperative PROs were compared between the 2 groups. A multivariate logistic regression analysis and ROC analysis were deployed to evaluate the correlation between PROs and the need for future surgery. RESULTS A total of 911 primary arthroscopy cases were included in this study. While age, body mass index, labral treatment, and 3-month and 1-year follow-up mHHS, NAHS, and VAS were significant in the bivariate analysis, the multivariate logistic regression analysis only found 1-year mHHS to be significant in the final model (P < .05). The ROC curve for 1-year mHHS demonstrated acceptable discrimination between patients requiring secondary surgery and patients not requiring secondary surgery with an area under the curve of 0.73. Using the Youden index, a threshold of 80.5 was determined for the 1-year mHHS. CONCLUSION The risk for secondary procedures may be evaluated with mHHS at 1 year after primary hip arthroscopy. Surpassing a score of 80.5 may be associated with a 74.4% reduction in risk for either a revision hip arthroscopy or a conversion to hip replacement.
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Affiliation(s)
- Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Rishika Bheem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Cynthia Kyin
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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20
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Abstract
Psychotic disorders in ICD-11: the revisions Abstract. This article provides an overview of the main changes to the chapter "Schizophrenia or Other Primary Psychotic Disorders" (6A2) from ICD-10 to ICD-11 and compares them with the psychosis chapter of DSM-5. These changes include abandoning the classical subtypes of Schizophrenia as well as of the special significance of Schneider's first-rank symptoms, resulting in the general requirement of two key features (one must be a positive symptom) in the definition of "Schizophrenia" (6A20) and the allowance for bizarre contents in "Delusional Disorder" (6A24), which now includes "Induced Delusional Disorder" (F24). Further introduced are the focus on the current episode, the restriction of "Acute and Transient Psychotic Disorder" (6A23) to the former Polymorphic Disorder Without Schizophrenic Symptoms (F23.0), the diagnosis of delusional "Obsessive-Compulsive or Related Disorders" (6B2) exclusively as Obsessive-Compulsive Disorders, the specification of "Schizoaffective Disorder" (6A21), and the formulation of a distinct subchapter "Catatonia" (6A4) for the assessment of catatonic features in the context of several disorders. In analogy to DSM-5, ICD-11 now includes the optional category "Symptomatic Manifestations of Primary Psychotic Disorders" (6A25) for the dimensional quantification of symptoms. Again, developmental aspects remain unattended in in the ICD-11-definitions of psychotic disorders.
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Affiliation(s)
- Frauke Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.,Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Eva Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Chantal Michel
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz
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21
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Law JI, Crawford DA, Adams JB, Lombardi AV Jr. Metal-on-Metal Total Hip Revisions: Pearls and Pitfalls. J Arthroplasty 2020; 35:S68-72. [PMID: 32081501 DOI: 10.1016/j.arth.2020.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND At the turn of the 21st century, there was a re-emergence of metal-on-metal (MoM) articulation with 35% of all total hip arthroplasty implants having MoM articulation. Approximately 10 years after its peak use, MoM articulation began to decrease dramatically as revisions became more apparent because of adverse reaction to metal debris. Today, there are surveillance guidelines and reconstructive clinical pearls a surgeon should recognize. METHODS This article gives a literature-based overview of clinical pearls and discusses how to avoid pitfalls when performing revision of a metal-on-metal total hip arthroplasty. RESULTS Patients with MoM can be risk-stratified based on symptom, implant, and testing variables. Those patients who are symptomatic and/or develop adverse reaction to metal debris with local tissue destruction will require a revision. The revision of MoM can be challenging due to bone and soft tissue destruction. Constraint may be needed in cases of abductor deficiency. CONCLUSION Although MoM implants for THA have declined significantly, surgeons are still faced with the revision burden from a decade of high use. Risk stratification tools are available to aid in revision decision making, and the surgeon should be prepared to address the challenges these revisions present.
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22
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Abstract
The following article elaborates on the need for the Other in order to delineate the self and one's identity, and the eternal psychological process of turning the Other into an enemy. A parallel process, which can be observed nowadays, leads to a disregard for the otherness of the Other that results in the blurring of identity and an internal loss of the differentiation of intrapsychic structures. Both psychological processes share a dehumanizing approach which leads to neurosis and alienation. In order to withstand these tendencies, a revision of analytical psychology's view of the psyche and of the practice of Jungian analysis is warranted: an alternative to the 'Fear of the Feminine' described by Erich Neumann in 1959. It is suggested that consciousness and unconsciousness intertwine but from a position of equality and reciprocity. Such an attitude does not inspire fear. Rather, it recognizes the need of one for the Other and the inevitability of this situation. Moreover, this need and interdependence on equal grounds nourish the wish to know the Other, to be aware of the differences, and yet, at the same time, to acknowledge how close the Other really is. Analytical psychological therapy based on this model stresses the power of the ego while also strengthening its capacity for introspection.
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23
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Sarpong NO, Grosso MJ, Lakra A, Held MB, Herndon CL, Cooper HJ. Hemiarthroplasty Conversion: A Comparison to Primary and Revision Total Hip Arthroplasty. J Arthroplasty 2019; 34:1168-1173. [PMID: 30890392 DOI: 10.1016/j.arth.2019.02.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 12/31/2018] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Arthroplasty is the standard of care for elderly patients with displaced femoral neck fractures, with viable options including hemiarthroplasty (HA) and total hip arthroplasty (THA). With time, HA may need to be converted to THA, but it is unclear whether this is more similar to primary or revision THA. We compare complication and revision rates between these groups within 90 days and 2 years postoperatively. METHODS We retrospectively reviewed 3 cohorts of patients treated at our institution: primary, conversion, and revision THA. Outcomes studied included intraoperative data, postoperative complications, and revision rates. We analyzed the groups using both parametric (analysis of variance test) and nonparametric (chi-squared test) statistics. RESULTS Operative time between primary THA (108.0 minutes), conversion HA (147.9 minutes), and revision THA (160.1 minutes) cohorts differed significantly (P = .011). Estimated blood loss was also different between primary THA (386 mL), conversion HA (587 mL), and revision THA cohorts (529 mL) (P = .011). At 2 years, major complication rates between primary THA (6.2%), conversion HA (11.7%), and revision THA (26.7%) cohorts also differed significantly (P = .003), as was the revision rate in the primary THA (4.6%), conversion HA (10.0%), and revision THA (18.3%) cohorts (P = .043). CONCLUSION This is the first study to compare short-term and midterm complications between primary, conversion, and revision THA. We observed conversion HA had similar operative time and estimated blood loss to revision THA, which was significantly higher than primary THA. However, we found that conversion HA more closely resembled primary THA with respect to perioperative complications rates.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Matthew J Grosso
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Akshay Lakra
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Michael B Held
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Abstract
This article lists proposed new or revised species names and classification changes associated with fungi of medical importance that were published in the years 2016 and 2017. While many of the revised names listed have been widely adopted without further discussion, some may take longer to achieve more general usage.
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Bullard MJ, Musgrave E, Warren D, Unger B, Skeldon T, Grierson R, van der Linde E, Swain J. Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) Guidelines 2016. CAN J EMERG MED 2017; 19:S18-27. [PMID: 28756800 DOI: 10.1017/cem.2017.365] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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26
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Abstract
This article lists proposed new or revised species names and classification changes associated with fungi of medical importance for the years 2012 through 2015. While many of the revised names listed have been widely adopted without further discussion, some may take longer to achieve more general usage.
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27
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Alentorn-Geli E, Samitier G, Torrens C, Wright TW. Reverse shoulder arthroplasty. Part 2: Systematic review of reoperations, revisions, problems, and complications. Int J Shoulder Surg 2015; 9:60-7. [PMID: 25937717 PMCID: PMC4410474 DOI: 10.4103/0973-6042.154771] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [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] [Indexed: 11/22/2022]
Abstract
Purpose: Many factors influence the reoperations, revisions, problems, and complications of reverse shoulder arthroplasty (RSA). The purpose of this study was to compare those depending on the surgical approach, type of prosthesis, and indication for surgery through a comprehensive, systematic review. Materials and Methods: A literature search was conducted (1985 to June 2012) using PubMed, CINAHL, EBSCO–SPORTDiscus, and Cochrane Central Register of Controlled Trials. Levels I–IV evidence, in-vivo human studies (written in English with minimum of 2 years of follow-up and sample size of 10 patients) reporting reoperations, revisions, problems, and complications after RSA were included. The data obtained were analyzed depending on the surgical approach, type of prosthesis (with medialized or lateralized center of rotation), or indication for surgery. Results: About 37 studies were included involving 3150 patients (mean [SD] percentage of females, age, and follow-up of 72% [13], 71.6 years [3.8], and 45 months [20], respectively). Use of deltopectoral approach and lateralized prostheses had significantly higher risk of need for revision surgery (P = 0.008) and glenoid loosening (P = 0.01), but lower risk of scapular notch (P < 0.001), compared with medialized prostheses with same approach. RSA for revision of anatomic prosthesis demonstrated higher risk of reoperation (P < 0.001), revision (P < 0.001), hematoma (P = 0.001), instability (P < 0.001), and infection (P = 0.02) compared with most of the other indications. Conclusions: Lateralized prostheses had significantly higher glenoid loosening and need for revision surgery, but a significantly lower rate of scapular notching compared to medialized prostheses. The risk of reoperations, revisions, problems, and complications after RSA was increased in revision cases compared with other indications. Level of Evidence: Level IV.
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Affiliation(s)
- Eduard Alentorn-Geli
- Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar - Hospital del Mar & Hospital de l'Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Gonzalo Samitier
- Orthopaedics and Sports Medicine Institute, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Carlos Torrens
- Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar - Hospital del Mar & Hospital de l'Esperança, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Thomas W Wright
- Orthopaedics and Sports Medicine Institute, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
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Kirshblum SC, Waring W, Biering-Sorensen F, Burns SP, Johansen M, Schmidt-Read M, Donovan W, Graves DE, Jha A, Jones L, Mulcahey MJ, Krassioukov A. Reference for the 2011 revision of the International Standards for Neurological Classification of Spinal Cord Injury. J Spinal Cord Med 2011; 34:547-54. [PMID: 22330109 PMCID: PMC3232637 DOI: 10.1179/107902611x13186000420242] [Citation(s) in RCA: 410] [Impact Index Per Article: 31.5] [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: 10/31/2022] Open
Abstract
The latest revision of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) was available in booklet format in June 2011, and is published in this issue of the Journal of Spinal Cord Medicine. The ISNCSCI were initially developed in 1982 to provide guidelines for the consistent classification of the neurological level and extent of the injury to achieve reliable data for clinical care and research studies. This revision was generated from the Standards Committee of the American Spinal Injury Association in collaboration with the International Spinal Cord Society's Education Committee. This article details and explains the updates and serves as a reference for these revisions and clarifications.
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Affiliation(s)
- Steven C. Kirshblum
- Northern New Jersey SCI System, Kessler Institute for Rehabilitation, West Orange, NJ, USA,University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA,Correspondence to: Steven Kirshblum MD. Kessler Institute 1199 Pleasant Valley Way. West Orange, NJ 07052, USA.
| | | | - Fin Biering-Sorensen
- Clinic for Spinal Cord Injuries, University of Copenhagen, Rigshospitalet, Denmark
| | - Stephen P. Burns
- Northwest Regional SCI System, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Andrei Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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