Today’s Top Story

Study Finds Bariatric Surgery Could Impact Perioperative Complications of Posterior Lumbar Fusion

Bariatric surgery prior to elective posterior lumbar fusion could reduce a patient’s risk of medical complications and infection, but patients with a higher body mass index (BMI) may remain at an increased risk of infection, revision surgery, and readmission compared to patients with a normal BMI, according to a study published in the September issue of The Spine Journal. The retrospective cohort study included 156,517 patients undergoing posterior lumbar fusion surgery. They were categorized as having a history of bariatric surgery and obesity (n = 590); severe obesity (BMI > 40 kg/m 2, n = 5,791); and normal weight (BMI < 25 kg/m 2, n = 150,136). Researchers measured 30-day medical complications, surgical complications, death, readmission, and hospital length of stay (LOS). Compared to the severely obese group, bariatric surgery patients had significantly lower rates of respiratory failure, urinary tract infection, acute renal failure, overall medical complications, infection, and hospital LOS. Bariatric surgery and nonobese patients did not show significant differences in medical complications, but the bariatric surgery group had higher rates of infection, reoperation, and readmission.

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Other News

Soft Tissue Injury May Be Correlated with Neurovascular Damage in Pediatric SCHFx

A prospective study published in the October issue of the Journal of Pediatric Orthopaedics found a possible association between soft tissue damage and neurovascular injury in supracondylar humerus fractures (SHFs) in young patients. Researchers collected prospective data preoperatively and intraoperatively for 748 surgically treated pediatric SHFs between January 2010 and December 2013. Data included a detailed neurovascular examination and soft tissue status, including qualitative descriptives for swelling (mild/moderate/severe), ecchymosis, abrasions, skin tenting, and skin puckering. Preoperatively, 7.8 percent of patients (n = 41/526) had a nonpalpable pulse, which was associated with severe elbow swelling, tenting, puckering, ecchymoses, and open fracture. Patients with a loss of a palpable pulse from initial orthopaedic consult to time of surgery (n = 10) were more likely to have severe swelling and ecchymosis. Preoperative neurological injuries (n = 71/526) were associated with severe elbow swelling, tenting, puckering, and ecchymoses. Seventeen patients had a decline in neurological examination from the initial orthopaedic consult to surgery, which was associated with severe elbow swelling and ecchymoses.

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Transfibular Total Ankle Replacement May Have Positive Outcomes

A prospective study published online in Foot & Ankle International found that transfibular total ankle arthroplasty (TAA) may be a safe and effective option for patients with ankle arthritis. Researchers followed 89 transfibular TAA patients who underwent surgery between May 2013 and February 2016 and assessed clinical and radiographic outcomes preoperatively and at six, 12, and 24 months postoperatively. At final follow-up, researchers observed significant improvement in patients’ American Orthopaedic Foot & Ankle Society Ankle Hindfoot Score (from 33.8 to 88.5), visual analog scale (from 80.5 to 14.1), and Short Form-12 Physical and Mental Composite Scores (from 29.9 and 43.3 to 47.0 and 53.3, respectively). Ankle dorsiflexion improved (from 6.2 degrees to 24.2 degrees), as did plantarflexion (from 9.6 degrees to 18.1 degrees) No radiographic evidence showed tibial or talar lucency, and patients maintained neutral ankle alignment. Seven patients had surgery again to remove symptomatic hardware (six fibular plates, one syndesmotic screw), two patients had delayed wound healing, and one patient underwent operative débridement, removal of implants, and placement of an antibiotic spacer to treat a postoperative prosthetic infection.

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Long-term Follow-up: Fractures may be Most Common Failure after THA using Uncemented Stems

A study published online in The Journal of Arthroplasty found that periprosthetic femoral fracture (PFF) could be the most likely long-term failure following uncemented total hip arthroplasty (THA) with a tapered titanium stem. Authors of the long-term study retrospectively reviewed 354 hips that underwent uncemented THA with a tapered titanium stem. At a mean postoperative follow-up of 28 years, 184 hips were unavailable for review (due to death or loss of follow-up). Of the remaining hips, 27 fractures occurred, 15 hips required stem revision, and 10 were treated by open reduction and internal fixation. Two patients declined surgery. Postoperation, PFF probability was 1.6 percent at 10 years and 13.2 percent at 29 years. Researchers observed no correlation between fracture and sex, age at time of operation, cup revision, or Canal-fill-index.

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Study: ACL Tears may be Associated with Later Life Comorbidities

A study published online in the American Journal of Cardiology observed a possible correlation between anterior cruciate ligament (ACL) tears and nonmusculoskeletal effects later in life. National Football League (NFL) players who played since 1960 (n = 3,506) self-reported physician-diagnosed health conditions, and researchers estimated hazard ratios for joint replacement surgeries, myocardial infarction, sleep apnea, arthritis, dementia, and stroke by history of ACL tear during their professional career. Former NFL players who tore their ACL had approximately a two-fold increase in muscular skeletal comorbidities, including knee joint replacement and arthritis, compared to those without ACL tears. ACL tears were also associated with an increased risk of myocardial infarction and sleep apnea.

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Speaking of Sports Medicine

Ahead of the 20th Annual Sports Medicine Course, Brian J. Cole, MD, MBA, and codirectors CAPT (Ret.) Matthew T. Provencher, MD, MC USNR, and Kevin E. Wilk, DPT, PT, FAPTA, sat with AAOS Now and discussed some of sports medicine’s top-of-mind issues, trends in the field, and the orthopaedic community’s stance on biologics. The course will take place will take place in Park City, Utah, Jan. 30 to Feb. 3, 2019.

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Register for the 2018 AAOS Fall Meeting

The 2018 AAOS Fall Meeting will be held Oct. 25–27 at the JW Marriott San Antonio Hill Country Resort in San Antonio, Texas. You must have a current disclosure to register for and attend the meeting.

Learn more and register now…