Orthopedics Commons^™

The Impact Of Robotic Assistance For Lumbar Fusion Surgery On 90-Day Surgical Outcomes And 1-Year Revisions, Jeremy Heard, Yunsoo Lee, Nicholas D D'Antonio, Rajkishen Narayanan, Mark Lambrechts, John Bodnar, Caroline Purtill, Joshua Pezzulo, Dominic Farronato, Pat Fitzgerald, Jose Canseco, Ian Kaye, Alan Hilibrand, Alex Vaccaro, Christopher Kepler, Gregory Schroeder

Department of Orthopaedic Surgery Faculty Papers

Objectives: To evaluate the (1) 90-day surgical outcomes and (2) 1-year revision rate of robotic versus nonrobotic lumbar fusion surgery. Methods: Patients >18 years of age who underwent primary lumbar fusion surgery at our institution were identified and propensity-matched in a 1:1 fashion based on robotic assistance during surgery. Patient demographics, surgical characteristics, and surgical outcomes, including 90-day surgical complications and 1-year revisions, were collected. Multivariable regression analysis was performed. Significance was set to P < 0.05. Results: Four hundred and fifteen patients were identified as having robotic lumbar fusion and were matched to a control group. Bivariant analysis revealed no significant difference in total 90-day surgical complications (P = 0.193) or 1-year revisions (P = 0.178). The operative duration was longer in robotic surgery (287 + 123 vs. 205 + 88.3, P ≤ 0.001). Multivariable analysis revealed that robotic fusion was not a significant predictor of 90-day surgical complications (odds ratio [OR] = 0.76 [0.32-1.67], P = 0.499) or 1-year revisions (OR = 0.58 [0.28-1.18], P = 0.142). Other variables identified as the positive predictors of 1-year revisions included levels fused (OR = 1.26 [1.08-1.48], P = 0.004) and current smokers (OR = 3.51 [1.46-8.15], P = 0.004). Conclusion: Our study suggests that robotic-assisted and nonrobotic-assisted lumbar fusions are associated with a similar risk of 90-day surgical complications and 1-year revision rates; however, robotic surgery does increase time under anesthesia.

A Systematic Review Of The Social Determinants Of Health In Shoulder Arthroplasty Outcomes, Allison Boland, John Pum, Michael Gaudiani, Matthew A. Gasparro

Medical Student Research Symposium

This systematic review investigates the impact of social determinants of health (SDOH) on outcomes in shoulder arthroplasty (SA). SA, a common orthopedic procedure, has seen an increasing focus on SDOH influencing postoperative results. The study aims to comprehensively assess this impact on both surgical and patient-reported outcomes.

Through a systematic search of databases, 34 studies (2011-2021) met the inclusion criteria, involving 4,825,547 patients. Explored SDOH included insurance status, race/ethnicity, age, sex, income, social support, and veteran status. Outcomes considered were length of stay, American Shoulder and Elbow Surgeons scores, total SA rates, revision rates, complication rates, and discharge status.

Findings …

Lateral Approach To The Lumbar Spine: The Utility Of An Access Surgeon, Matthew Meade, Yunsoo Lee, Parker Brush, Mark Lambrechts, Eleanor Jenkins, Cristian Desimone, Michael Mccurdy, John Mangan, Jose Canseco, Mark Kurd, Alan Hilibrand, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Lateral lumbar interbody fusions (LLIFs) utilize a retroperitoneal approach that avoids the intraperitoneal organs and manipulation of the anterior vasculature encountered in anterior approaches to the lumbar spine. The approach was championed by spinal surgeons; however, general/vasculature surgeons may be more comfortable with the approach.

OBJECTIVE: The objective of this study was to compare short-term outcomes following LLIF procedures based on whether a spine surgeon or access surgeon performed the approach.

MATERIALS AND METHODS: We retrospectively identified all one- to two-level LLIFs at a tertiary care center from 2011 to 2021 for degenerative spine disease. Patients were divided into …

Effect Of Drain Duration And Output On Perioperative Outcomes And Readmissions After Lumbar Spine Surgery, Brian A. Karamian, Parth Kothari, Gregory R. Toci, Mark J. Lambrechts, Jose A. Canseco, Jennifer Mao, Raj Narayan, Sammy Alfonsi, Francis Sirch, Nadim Kheir, Nicholas Semenza, Barrett I. Woods, Jeffrey A. Rihn, Mark Kurd, Kris Radcliff, I David Kaye, Alan S. Hilibrand, Christopher K. Kepler, Alex R. Vaccaro, Gregory D. Schroeder

Rothman Institute Faculty Papers

Study design: Single-center retrospective cohort.

Purpose: To compare surgical outcomes of patients based on lumbar drain variables relating to output and duration.

Overview of literature: The use of drains following lumbar spine surgery, specifically with respect to hospital readmission, postoperative hematoma, postoperative anemia, and surgical site infections, has been controversial.

Methods: Patients aged ≥18 years who underwent lumbar fusion with a postoperative drain between 2017 and 2020 were included and grouped based on hospital readmission status, last 8-hour drain output (<40 mL cutoff), or drain duration (2 days cutoff). Total output of all drains, total output of the primary drain, drain duration in days, drain output per day, last 8-hour output, penultimate 8-hour output, and last 8-hour delta (last 8-hour output subtracted by penultimate 8-hour output) were collected. Continuous and categorical data were compared between groups. Multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis were performed to determine whether drain variables can predict hospital readmission, postoperative blood transfusions, and postoperative anemia. Alpha was 0.05.

Results: Our cohort consisted of 1,166 patients with 111 (9.5%) hospital readmissions. Results of regression analysis did not identify …

Unicompartmental Knee Arthroplasty Is Associated With A Lower Rate Of Periprosthetic Joint Infection Compared To Total Knee Arthroplasty, Cody S. Lee, Edwin P. Su, Michael B. Cross, Alberto V. Carli, David C. Landy, Brian P. Chalmers

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Several studies have reported lower perioperative complications with unicompartmental knee arthroplasty (UKA) than with total knee arthroplasty (TKA). However, there is a paucity of data analyzing the incidence of periprosthetic joint infection (PJI) in similar patients undergoing UKA and TKA. As such, we sought to analyze the incidence of UKA and TKA PJI in a large matched population.

Material and Methods: The Mariner data set of the PearlDiver database was queried for all patients undergoing UKA or TKA during 2010-2017. Included patients were required to have at least 2 years of database inclusion after surgery. Patients were then matched …

Osseous Changes Following Reverse Total Shoulder Arthroplasty Combined With Latissimus Dorsi Transfer: A Case Series, Jason S Klein, Peter S Johnston, Benjamin W Sears, Manan S Patel, Armodios M Hatzidakis, Mark D. Lazarus

Department of Orthopaedic Surgery Faculty Papers

Background: This is the first report on the incidence of proximal humerus osseous changes and associated clinical consequences in reverse total shoulder arthroplasty combined with a latissimus dorsi tendon transfer (RTSA+LDT).

Methods: A multicenter, retrospective review identified all patients who had undergone a primary RTSA+LDT and had at least 3-month radiographic follow-up between 2012 and 2017. Data collection included demographics, oral steroid use, repair technique for LDT fixation, radiographic humeral osseous changes, complications, and need for revision surgery.

Results: Twenty-four patients were included with an average age of 70.7 ± 7.9 years and follow-up of 16.3 (3-50) months. Ten patients …

Preoperative Maximization To Reduce Complications In Spinal Surgery, Sukanta Maitra, Christopher Mikhail, Samuel K. Cho, Michael D. Daubs

School of Medicine Faculty Publications

Study design: Invited narrative review. Objectives: The aim of this review was to summarize current literature regarding risk factors that surgeons can optimize in the preoperative setting in the spinal surgery patient, in order to reduce complications and improve patient-reported outcomes. Methods: Review of the relevant literature by the authors. Results: Modifiable risk factors identified relative to the patient include obesity, malnutrition/nutrient deficiency, diabetes/hyperglycemia, preoperative anemia, vitamin D/DEXA (dual-energy radiograph absorptiometry), nicotine use/smoking, and opioid use/psychosocial factors. Conclusion: By maximizing a patient's physiological and psychological status prior to elective spine surgery, we may move closer to achieving the goals of …

Oral Contraceptive Pills Are Not A Risk Factor For Deep Vein Thrombosis Or Pulmonary Embolism After Arthroscopic Shoulder Surgery, Austin V. Stone, Avinesh Agarwalla, Anirudh K. Gowd, Cale A. Jacobs, Jeffrey A Macalena, Bryson P. Lesniak, Nikhil N. Verma, Anthony A. Romeo, Brian Forsythe

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis.

Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery.

Study Design: Cohort study; Level of evidence, 3.

Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking …

Outcomes Of Shoulder Arthroplasty Performed For Postinfectious Arthritis., Eric M. Padegimas, Thema A. Nicholson, Stephen Silva, Matthew L. Ramsey, Gerald R. Williams, Mark D. Lazarus, Surena Namdari

Rothman Institute Faculty Papers

Background: The purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis.

Methods: This is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations.

Results: The 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m

Conclusions: Shoulder arthroplasty after septic arthritis had inconsistent functional outcomes and high complication rates …

Intraoperative Femoral Head Dislodgement During Total Hip Arthroplasty: A Report Of Four Cases, Ahmed Siddiqi, Carl T. Talmo, James V. Bono

Orthopedic Surgery Resident Research

Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.

Comparing Mid Lumbar Interbody Fusion (Midlf) With Traditional Posterior Lumbar Interbody Fusion (Plif), Joel T. Phillips

Electronic Thesis and Dissertation Repository

Mid-lumbar interbody fusion (MIDLF) uses a novel cortical bone trajectory (CBT) screw that provides robust fixation that is less dependent on cancellous bone quality than a traditional pedicle screw. MIDLF also allows for decompression and instrumentation through a smaller central surgical window. The aim of this study is to compare MIDLF with posterior lumbar interbody fusion (PLIF) with regards to perioperative complications, operative time, blood loss, length in hospital, radiographic outcomes and post-operative patient functional scores. A retrospective review of our institutional database was performed of patients undergoing MIDLF. Matched PLIF controls were then selected from the same database for …

Outcomes Of Internal Hemipelvectomy For Pelvic Tumors: A Developing Country’S Prospective, Masood Umer, Rizwan Haroon Rashid, Yasir Mohib, Haroon Rashid

Department of Surgery

Introduction: Previously, external hemipelvectomy was the mainstay of treatment for pelvic tumors. However, with technological advancements, limb salvage procedures such as internal hemipelvectomy have emerged as a viable alternative. However, there is limited literature available on long-term outcomes and complications of internal hemipelvectomy, especially from developing countries. Therefore, the objective of this study was to share our experience of internal hemipelvectomy at a tertiary care center in a developing country. Materials and methods: A retrospective review was conducted in which all 24 patients undergoing internal hemipelvectomy from January 1, 2005 to December 31, 2015 at our institution were included. Medical …

Epidural Hematoma Following Cervical Spine Surgery., Gregory D. Schroeder, Alan S. Hilibrand, Paul M. Arnold, David E. Fish, Jeffrey C. Wang, Jeffrey L. Gum, Zachary A. Smith, Wellington K. Hsu, Ziya L. Gokaslan, Robert E. Isaacs, Adam S. Kanter, Thomas E. Mroz, Ahmad Nassr, Rick C. Sasso, Michael G. Fehlings, Zorica Buser, Mohamad Bydon, Peter I. Cha, Dhananjay Chatterjee, Erica L. Gee, Elizabeth L. Lord, Erik N. Mayer, Owen J. Mcbride, Emily C. Nguyen, Allison K. Roe, P. Justin Tortolani, D. Alex Stroh, Marisa Y. Yanez, K. Daniel Riew

Rothman Institute Faculty Papers

STUDY DESIGN: A multicentered retrospective case series.

OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine.

METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified.

RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an …

Current Issues In Treatment Of Anterior Shoulder Instability: A Review, Ian Power

UNM Orthopaedic Research Journal

Anterior shoulder instability can be problematic in the young, active population, particularly in athletes and military personnel. The shoulder joint is the most frequently dislocated joint, and there is a high rate of dislocation recurrence in younger patients. The stability of the glenohumeral joint is conferred through the bony anatomy and the static and dynamic stabilizers. Recognizing pathological features, identifying glenoid bone loss, and detecting Bankart and Hill-Sachs lesions are key to formulating an appropriate treatment strategy and improving surgical outcomes. Furthermore, the concept of critical bone loss has been refined by looking at subcritical loss. Recent evidence has shown …

Total Ankle Replacement, Then And Now: A Review, Katherine J. Gavin

UNM Orthopaedic Research Journal

Total ankle replacement (TAR) for treating end-stage osteoarthritis of the ankle joint has been evolving since the early 1960s. Increased understanding of the biomechanics and kinematics of the foot and ankle, postoperative results of implant use, and advances in technology have led to improved implant designs and treatment outcomes. The current study reviews associated historical perspectives, kinematics, biomechanics, patient selection, imaging procedures, modern surgical techniques, postoperative complications, and comparison studies with arthrodesis to help evaluate TAR in successfully treating osteoarthritis of the ankle joint. Although arthrodesis remains the gold standard for treatment, findings of new studies have suggested that TAR …

Ruptures Of The Quadriceps And Patellar Tendons Of The Extensor Mechanism: A Review, Judd R. Fitzgerald

UNM Orthopaedic Research Journal

Damage to the quadriceps and patellar tendons of the extensor mechanism can be devastating and often life-changing injuries that require prompt diagnosis and treatment. A sound understanding of anatomy, biomechanics, and degenerative changes of both tendons and the extensor mechanism of the knee can help guide surgical repair and postoperative rehabilitation of patients. Immediate primary repair has often resulted in improved postoperative results compared with delayed reconstruction, and the avoidance of gap formation by use of careful techniques and augmentation has been critical for successful treatment. Additionally, patients with extensor mechanism injuries frequently have medical comorbidities or notable tendon degeneration; …

Investigating Potential Role Of Surgeons In Sternal Wire Failure By Biomechanical Tests, Christina Salas, Rachel N. Tufaro, C Etta Tabe, Kwasi Addae-Mensah, W Daniel Tanberg, Christopher Buksa, Jessica A. Avila, Jorge A. Wernly

UNM Orthopaedic Research Journal

Background: Stainless steel wires are commonly used to close the sternum after cardiac-related operative procedures. However, complications have been reported associated with fracture of wires and subsequent migration into the chest cavity. The objective of this study was to biomechanically evaluate the role of surgeons in contributing to wire failure. We hypothesized that surgeons may impose damage to the sternal wire, which may be exacerbated by postoperative wire degradation and patient movement.

Methods: A biomimetic sternal model and custom test fixture simulated a median sternotomy. The sternum was closed by a fellowship-trained cardiothoracic surgeon using figure-of-eight and simple closure techniques. …

Complications Of Total Hip Replacement, Kashif Abbas, Ghulam Murtaza, Masood Umer, Haroon Rashid, Irfan Qadir

Section of Orthopaedic Surgery

Objective: To determine the factors causing complications in unilateral total hip replacement.
Study Design: Analytical study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, between 2000 and 2010.
Methodology: During the study period, 199 patients underwent elective unilateral total hip replacement at the Aga Khan University Hospital. Patients were divided into two groups on the basis of postoperative complications within 30 days of surgery. Significant factors at 5% significance level on univariate analysis were further analyzed by multivariate logistic regression.
Results: Postoperative complications occurred in 39 patients (19.6%); dislocation being most common in 13 patients (6.5%), followed …