Hypoalbuminemia Increases Mortality after Two-Stage Revision Total Joint Arthroplasty.

Objectives: This study aimed to evaluate the effect of hypoalbuminemia on failure rates and mortality after a two-stage revision for PJI.

Methods: 199 Patients (130 knees and 69 hips) with a mean age of 64.7 ± 10.

Intraoperative Acoustics: Auditory Cues in Hip Reconstructive Surgery.

Background: Orthopaedic surgeons rely on visual and tactile cues to guide performance in the operating room (OR). However, there is very little data on how sound changes during orthopaedic procedures and how surgeons incorporate audio feedback to guide performance. This study attempts to define meaningful changes in sound during vital aspects of total hip arthroplasty (THA) within the spectrum of human hearing.

The Cost-Effectiveness of Tibial Metaphyseal Cones in Revision Total Knee Arthroplasty.

Background: The purpose of this study is to evaluate the cost-effectiveness of tibial cones in revision total knee arthroplasty.

Methods: A Markov model was used for cost-effectiveness analysis. The average cone price was obtained from Orthopedic Network News.

Low Socioeconomic Status Is Associated With Increased Complication Rates: Are Risk Adjustment Models Necessary in Cervical Spine Surgery?

Study Design: Retrospective cohort study.

Objectives: The objective of this study was to determine whether lower socioeconomic status was associated with increased resource utilization following anterior discectomy and fusion (ACDF).

Methods: The National Inpatient Sample database was queried for patients who underwent a primary, 1- to 2-level ACDF between 2005 and 2014.

National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database.

Background: Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.

Are Patients Who Undergo THA for Infection at Higher Risk for 30-day Complications?

Background: Value-based payment models, such as bundled payments, continue to become more widely adopted for total joint arthroplasty. However, concerns exist regarding the lack of risk adjustment in these payment and quality reporting models for THA. Providers who care for patients with more complicated problems may be financially incentivized to screen out such patients if reimbursement models fail to account for increased time and resources needed to care for these more complex patients.

Short-term Outcomes Following Cervical Laminoplasty and Decompression and Fusion With Instrumentation.

Study Design: Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2010 to 2015.

Objective: Investigate which short-term outcomes differ for cervical laminoplasty and laminectomy and fusion surgeries.

Summary Of Background Data: Conflicting reports exist in spine literature regarding short-term outcomes following cervical laminoplasty and posterior laminectomy and fusion.

Risk Adjustment Is Necessary in Value-based Outcomes Models for Infected TKA.

Background: The Medicare Access and CHIP Reauthorization Act of 2015 provides the framework to link reimbursement for providers based on outcome metrics. Concerns exist that the lack of risk adjustment for patients undergoing revision TKA for an infection may cause problems with access to care.

Questions/purposes: (1) After controlling for confounding variables, do patients undergoing revision TKA for infection have higher 30-day readmission, reoperation, and mortality rates than those undergoing revision TKA for aseptic causes? (2) Compared with patients undergoing revision TKA who are believed not to have infections, are patients undergoing revision for infected TKAs at increased risk for complications?

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients undergoing revision TKA from 2012 to 2015 identified by Current Procedural Terminology (CPT) codes 27486, 27487, and 27488.

Arm Pain Versus Neck Pain: A Novel Ratio as a Predictor of Post-Operative Clinical Outcomes in Cervical Radiculopathy Patients.

Background: Informed patient selection and counseling is key in improving surgical outcomes. Understanding the impact that certain baseline variables can have on postoperative outcomes is essential in optimizing treatment for certain symptoms, such as radiculopathy from cervical spine pathologies. The aim was to identify baseline characteristics that were related to improved or worsened postoperative outcomes for patients undergoing surgery for cervical spine radiculopathic pain.

Intraoperative bladder perforation during primary total hip arthroplasty.

We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature.

Two-Year Results of the Prospective Spine Treatment Outcomes Study: Analysis of Postoperative Clinical Outcomes Between Patients with and without a History of Previous Cervical Spine Surgery.

Objective: History of previous cervical spine surgery is a frequently cited cause of worse outcomes after cervical spine surgery. The purpose of this study was to determine any differences in clinical outcomes after cervical spine surgery between patients with and without a history of previous cervical spine surgery.

Methods: A multicenter prospective database was reviewed retrospectively to identify patients with cervical spondylosis undergoing surgery with a minimum 2-year follow-up.

Complications and Mortality Following Total Hip Arthroplasty in the Octogenarians: An Analysis of a National Database.

Background: As advances in medicine have increased life expectancy, more octogenarians are undergoing total hip arthroplasty (THA) than ever before. Concerns exist, however, about the safety of performing this elective procedure in this age group. The purpose of this study is to determine the 30-day complications associated with THA patients over 80 years of age and to identify high-risk patients.

Are Revision Hip Arthroplasty Patients at Higher Risk for Venous Thromboembolic Events Than Primary Hip Arthroplasty Patients?

Background: The purpose of this study is to determine whether revision total hip arthroplasty (THA) is associated with increased rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) when compared to primary THA.

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program database for all primary and revision THA cases from 2011 to 2014. Demographic data, medical comorbidities, and venous thromboembolic rates within 30 days of surgery were compared between the primary and revision THA groups.

Cervical spondylotic myelopathy: National trends in the treatment and peri-operative outcomes over 10years.

Background: Recent studies show increases in cervical spine surgery prevalence and cervical spondylotic myelopathy (CSM) diagnoses in the US. However, few studies have examined outcomes for CSM surgical management, particularly on a nationwide scale.

Objective: Evaluate national trends from 2001 to 2010 for CSM patient surgical approach, postoperative outcomes, and hospital characteristics.

Bone morphogenetic protein in adult spinal deformity surgery: a meta-analysis.

Introduction: Since its introduction BMP has been utilized in populations with higher rates of malunion, such as adult spinal deformity (ASD) patients. Contradictory conclusions exist in spinal literature regarding the safety and efficacy of the use of BMP in this setting. Previous studies, however, did not distinguish deformity cases from spondylolisthesis or stenosis.

Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database.

Background: As outpatient total hip (THA) and knee arthroplasties (TKA) increase in popularity, concerns exist about the safety of discharging patients home the same day. The purpose of this study is to determine the complications associated with outpatient total joint arthroplasty (TJA) and to identify high-risk patients who should be excluded from these protocols.

Methods: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients who underwent primary TKA or THA from 2011 to 2014.

Pre-Operative Autologous Blood Donation Does Not Affect Pre-Incision Hematocrit in Adolescent Idiopathic Scoliosis Patients. A Retrospective Cohort of a Prospective Randomized Trial.

Background: Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been used in deformity surgery. The effect of pre-donation on pre-operative hematocrit (Hct) remains debated. Multiple factors may influence pre-operative Hct including intravascular volume status, patient factors, and timing of pre-operative blood donation.

Management of Spinal Deformity in Adult Patients With Neuromuscular Disease.

A wide range of neuromuscular diseases, including Parkinson disease, cerebral palsy, multiple sclerosis, and myopathy, are associated with spinal deformities. The most common postural deformities include anterocollis, Pisa syndrome (pleurothotonus), scoliosis, and camptocormia. Nonsurgical management of spinal deformity in patients with neuromuscular disease centers on maximizing the medical management of the underlying neurodegenerative pathology before surgical intervention is contemplated.

Emerging Techniques for Posterior Fixation of the Lumbar Spine.

Pedicle screw fixation is the preferred method of posterior fusion in lumbar spinal surgery. The technique provides three-column support of the vertebrae, contributing to the biomechanical strength of the construct. However, open pedicle screw fixation often necessitates wide posterior exposure and dissection with soft-tissue disruption of the facet joint.

Predictors of Revision Surgical Procedure Excluding Wound Complications in Adult Spinal Deformity and Impact on Patient-Reported Outcomes and Satisfaction: A Two-Year Follow-up.

Background: The surgical procedure to treat adult spinal deformity is challenging, with high rates of complications, including revision procedures performed to repair instrumentation failure or unplanned surgical complications. This study quantifies the incidence of, identifies predictors for, and determines health-related quality-of-life changes associated with revision procedures to treat adult spinal deformity.

Methods: We analyzed a multicenter database of patients who underwent a surgical procedure for adult spinal deformity, which was defined as having an age of eighteen years or older and scoliosis of ≥20°, sagittal vertical axis of ≥5 cm, pelvic tilt of ≥25°, and/or thoracic kyphosis of >60°.

The Impact of Advanced Age on Peri-Operative Outcomes in the Surgical Treatment of Cervical Spondylotic Myelopathy: A Nationwide Study Between 2001 and 2010.

Study Design: Retrospective multicenter database review.

Objective: The aim of this study was to evaluate national postoperative outcomes and hospital characteristics trends from 2001 to 2010 for advanced age CSM patients.

Summary Of Background Data: Recent studies show increases in US cervical spine surgeries and CSM diagnoses.

Functional Knee Outcomes in Infrapatellar and Suprapatellar Tibial Nailing: Does Approach Matter?

We conducted a study to determine differences in knee pain in patients who underwent either traditional infrapatellar nailing or suprapatellar nailing. From a single institution, we identified patients who had an isolated tibial shaft fracture (Orthopaedic Trauma Association type 42 A-C) surgically fixed with an intramedullary nail between 2009 and 2012. Each patient was contacted by telephone by an investigator blinded to surgical exposure, and the Oxford Knee Score (OKS) questionnaire was administered.

Surgical Treatment Strategies for High-Grade Spondylolisthesis: A Systematic Review.

Background: HGS is a severe deformity most commonly affecting L5-S1 vertebral segment. Treatment available for HGS includes a range of different surgical options: full or partial reduction of translation and/or abnormal alignment and in situ fusion with or without decompression. Various instrumented or non-instrumented constructs are available, and surgical approach varies from anterior/posterior to combined depending on surgeon preference and experience.