The Impact of Preoperative Co-morbidities on Blood Transfusion Requirements Following Reverse Total Shoulder Arthroplasty.

Objectives: Reverse total shoulder arthroplasty (RTSA) continues to increase in popularity as a surgical operation in the United States. As indications for this procedure expand, more attention is needed to evaluate perioperative risk factors and patient characteristics. Postoperative anemia requiring blood transfusion (BT) is a well-documented risk factor for increased in-house mortality although little has been studied on the relationship between RTSA and postoperative BT. The purpose of this study was to identify comorbidities and patient characteristics as risk factors for BT in patient's undergoing RTSA. Methods: Using the Nationwide Inpatient Sample (NIS) database, 59,925 RTSA patients (2016-2019) were analyzed, with 1.96% requiring postoperative BT. Demographics, comorbidities, and preoperative factors were compared between BT and non-BT groups via univariate and multivariate analyses. Results: Overall prevalence of blood transfusion in all patients was 1.96%. Male sex (OR 1.75, p < 0.001), Asian ethnicity (OR 1.96, p = 0.012), age >80 (OR 1.51, p < 0.001), age >90 (OR 2.26, p < 0.001), CKD (OR 1.94, p < 0.001), and Parkinson's disease (OR 2.08, p < 0.001) were associated with increased BT odds. Cirrhosis exhibited the highest impact (OR 5.7, p < 0.001). Conversely, Caucasian ethnicity (OR 0.76, p = 0.023), uncomplicated DM (OR 0.73, p = 0.002), tobacco-related disorders (OR 0.43, p < 0.001), BMI >30 (OR 0.8, p = 0.011), and elective procedures (OR 0.16, p < 0.001) decreased BT odds. Conclusion: These results were useful with identifying several risk factors that predispose to a higher risk of postoperative BT in patients undergoing RTSA including male sex, people of Asian descent, age > 80, CKD, Parkinson's disease, and cirrhosis. These findings provide clinicians with information that may be helpful with preoperative planning and perioperative management of complex patient populations.

The impact of prior ACL reconstruction on total knee arthroplasty outcomes: a retrospective matched cohort study.

INTRODUCTION: Discrepant data exists regarding the outcomes following total knee arthroplasty (TKA) with a prior anterior cruciate reconstruction (ACLR). The purpose of our study was to compare surgical and medical outcomes in the patients with prior ACLR undergoing TKAs compared to a matched control group of the patients who had undergone TKAs without prior ACLR. We hypothesized that the patients with prior ACLR would have inferior clinical outcomes. MATERIAL/METHODS: We retrospectively queried the PearlDiver-database for patients who underwent TKA following ACLR from 2011 to 2020. We used propensity-score matching to create two cohorts. The two-sided independent t-test and Chi-Squared test were used. RESULTS: We identified 2,174 patients who had prior ACLR before the TKAs. There were another 1,348,870 patients who did not have ACLR before the TKAs. After matching, each group had 2,171 patients. The ACLR-TKA group had significantly lower rates of aseptic revision at 2 years (1.2% vs. 4.0%, OR 0.3, p < 0.01), PJI requiring antibiotic spacer at 2 years (0.3% vs. 0.8%, OR 0.35, p = 0.02), and MUA at 90 days (0.4% vs. 7.5%, OR 0.05, p < 0.01). The rate of wound disruption was lower for the ACLR-TKA group at 90 days (p = 0.03) as were several medical complications including AKI at 90 days (p < 0.01), DVT at 90 days (p < 0.01), pneumonia at 90 days (0.04), and required blood transfusion at 90 days (p < 0.01). CONCLUSION: These results differed from our expectations. Within the limitations of the study, we are unable to determine the factors for the lower complications in the ACLR-TKA group. The data from this study are different from what had been reported in the previous studies.

Clinical Outcomes of Single-Stage Revision Anterior Cruciate Ligament Reconstruction Using a Fast-Setting Bone Graft Substitute.

Revision anterior cruciate ligament reconstruction (ACLR) can be achieved in a single-stage or two-stage approach. Single-stage revisions have several advantages, including one less operation, decreased cost, and a quicker recovery for patients. Revision ACLR can be complicated by malpositioned or dilated bone tunnels, which makes a single-stage revision more challenging or sometimes necessitates a two-stage approach. The use of fast-setting bone graft substitutes (BGS) has been described in recent literature as a strategy to potentially help address this problem in the setting of single-stage revision ACLR. The aim of this study was to evaluate patient-reported clinical outcomes of patients who have undergone single-stage revision ACLR using fast-setting BGS to address prior malpositioned or dilated tunnels. A retrospective review was conducted of the first nine consecutive patients who had undergone single-stage revision ACLR using a fast-setting BGS by a single surgeon between May 2017 and February 2020 with a minimum of 2-year follow-up. Patient-reported clinical outcomes, including the International Knee Documentation Committee (IKDC) questionnaire, the Tegner Lysholm Knee Scoring Scale, patient satisfaction questions, and the need for additional surgery were evaluated for this group between 26 and 49 months postoperative. Of the nine patients eligible for inclusion, eight patients (88.9%) were evaluated, and one was lost to follow-up. At an average follow-up of 37.9 months (range: 27.8-55.7), the mean postoperative IKDC score was 75.0 ± 11.3, and the mean postoperative Tegner Lysholm Knee Score was 83.0 ± 17.6. None of the patients required additional revision surgery or experienced construct failure at the time of follow-up. Seven of eight respondents (87.5%) had their preoperative expectations met with the surgery, and 100% of patients stated they would have the surgery again. Single-stage revision ACLR using fast-setting BGS showed overall positive clinical outcomes for this pilot group of patients at a minimum 2-year follow-up. In select revision scenarios, these materials may be a valuable option to allow the filling of defects without compromising fixation or clinical outcomes.

Comparative Analysis of Unicompartmental Total Knee Arthroplasty and High Tibial Osteotomy: Time to Total Knee Arthroplasty and Other Outcome Measures.

Background: There is no consensus on whether unicompartmental arthroplasty (UKA) or high tibial osteotomy (HTO) is superior for unicompartmental arthritis. While there are studies comparing revision and complication rates, none matched a large number of patients undergoing HTO and UKA in the United States and compared these outcomes. We investigated TKA conversion rate and the complications following HTO or UKA. Methods: This retrospective study queried the PearlDiver database of all patients undergoing UKA and HTO using CPT codes between January 2011 and January 2020. We compared propensity-matched populations based on age, gender, Charlson comorbidity index, and Elixhauser comorbidity index to compare odds of complications, TKA conversion, and drug use between UKA and HTO groups. Two-independent sample t-test for unequal variances and test of significance were performed. Results: We found 32,583 UKA patients and 816 HTO patients. Each matched group had 535 patients. One-year complication showed higher risk of pneumonia, hematoma, infection, and mechanical complications among HTO patients. UKA patients used narcotics on average of 10.3 days compared to 9.1 days among HTO patients (P < .01). UKA conversion rates were 4.1%, 5.4%, 7.7%, and 9.2% at 1-, 2-, 5-, and 10-year intervals, respectively. HTO conversion rates were less than 2% at 1- and 2-year intervals, 3.4% at 5-year, and 4.5% at 10-year intervals. This difference was statistically significant at 5- and 10-year intervals (P < .01). Conclusions: Using large matched cohorts, HTO may be converted to TKA later than UKA in short- to mid-term follow-up, and HTO patients used opioids for shorter duration.

Radiographic Predictors of Reoperation in Adolescents Undergoing Hip Preservation Surgery for Femoroacetabular Impingement.

BACKGROUND: Femoroacetabular impingement (FAI) is a condition caused by repetitive abutment of a morphologically abnormal proximal femur and/or acetabulum that may result in chondral and labral pathology. An understanding of radiographic parameters associated with successful primary surgery has not been well established. PURPOSE: To determine preoperative radiographic parameters that predict reoperation for FAI and correlate radiographic measurements with outcomes in these patients. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A prospectively collected institutional registry of adolescent patients (age, <19 years) who underwent surgery for FAI (arthroscopic/open) was reviewed. Preoperative standing anteroposterior pelvic radiographs were analyzed for femoroepiphyseal acetabular roof (FEAR) index, as well as lateral center-edge angle (LCEA) and alpha, Tönnis, and Sharp angles. Patient-reported outcomes (PROs) (modified Harris Hip Score, Hip disability and Osteoarthritis Outcome Score) were analyzed preoperatively and at 1- and 2-year followup. Radiographic indication of risk for reoperation was evaluated using receiver operating characteristic (ROC) analysis. Spearman correlation was calculated between radiographic measurements and PROs at 2 years postoperatively. RESULTS: A total of 81 patients (91 hips) underwent primary surgery (57 surgical dislocations vs 34 arthroscopies) for FAI. The mean age at time of primary operation was 16.23 years (range, 10.4-19.6 years) (73.6% female). Eleven hips (12.1%) underwent reoperation at a mean of 20.6 months from primary surgery. The LCEA, FEAR index, Tönnis angle, and Sharp angle before index surgery were significantly different (P < .05) between patients who underwent reoperation and those who did not. ROC analysis indicated that LCEA <22°, FEAR index >-8.7°, Tönnis angle >6.0°, and Sharp angle >44° were predictors for increased risk of reoperation. Using the cutoff values from the ROC analysis in this series, 43% of patients with an LCEA ≤22° had a repeat procedure, while only 8% of those with an LCEA >22° had a repeat procedure. Similar trends were seen with the other aforementioned acetabular radiographic measurements (FEAR index, Tönnis angle, Sharp angle). Patients who did not require a reoperation demonstrated significant improvement in all PRO categories from their preoperative to 2-year postoperative visits (P < .0001). CONCLUSION: In patients undergoing treatment for FAI, a reoperation was associated with radiographic signs of hip dysplasia, indicating that patients with a shallower acetabulum are at risk for a repeat operation.

Cost and Complications in Rheumatoid Arthritis Patients Undergoing Primary Hip Arthroplasty: A National Inpatient Sample-Based Study.

INTRODUCTION: Rheumatoid arthritis (RA) is an autoimmune disease that affects multiple synovial joints in the body, including the hip. Hip involvement in RA patients is fairly common, but the current literature is lacking large-scale studies on the surgical outcomes of RA patients undergoing total hip arthroplasty (THA). The aim of the study is to examine the outcomes and hospital costs associated with THA in patients with RA and compare them to patients without RA using the National Inpatient Sample (NIS) database. METHODS: We analyzed the NIS database to identify patients undergoing THA between 2016 and 2019 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Multiple variables including demographics, medical comorbidities, total hospital costs, length of stay, and perioperative complication rates were then compared between patients with and without RA. Further, the two groups were matched for demographic differences, if any, using a 1:1 propensity match algorithm. RESULTS: Patients with RA undergoing THA were significantly younger and predominantly female when compared to patients without RA. There was also a lower incidence of obesity and the percentage of elective THA procedures were smaller in the RA group. The RA group had a longer length of stay and increased incidences of blood loss anemia, blood transfusion, and periprosthetic fractures. These differences persisted despite matching the two groups for demographic differences, elective procedures, diabetes, obesity, and tobacco usage. CONCLUSION: THA in RA is associated with an increased incidence of blood loss anemia, blood transfusion, and periprosthetic fractures, as well as a longer length of stay in THA patients.