RESUMEN
Background: Body mass index (BMI) is an imperfect measure of patients' adiposity and operative risk. Radiographic and direct subcutaneous measurements have been utilized in attempts to more accurately characterize the risk of postoperative complications, including surgical site infection. This study aims to evaluate whether direct tissue depth measurement is a more accurate predictor of skin complication following direct anterior total hip arthroplasty (THA). Methods: A retrospective chart review of patients who underwent elective THA between April 30, 2020, and January 31, 2023, was performed. Baseline demographics, antibiotics, anticoagulation, and intraoperatively measured tissue depths at proximal, middle, and distal portions of the incision were recorded. Patient follow-up was reviewed to assess the development of skin complication in the acute postoperative period. Results: Data were collected from 280 patients who underwent THA via direct anterior approach by a single surgeon. The mean age was 66.0 years, and 52.1% were female. A total of 18/280 (6.4%) patients developed an abrasion (5/18) or superficial surgical site infection (13/18) within the first 60 days postoperatively. Patients who developed skin complications had a significantly higher BMI (33.7 kg/m2 vs 29.9 kg/m2; P = .0021). Patients with a BMI >30 kg/m2 had more than 5 times increased odds of developing a superficial skin complication in the acute 60-day postoperative period compared to those with a BMI <30 kg/m2 (Odds ratio = 5.318, P = .0059). None of the measured tissue depths, nor their average together, were shown to be significant predictors of skin complications. Conclusions: This study showed that BMI is a significant predictor of acute skin complications in direct anterior THA patients. No other significant predictors were found to be associated with increased risk, including proximal, middle, and distal tissue depths.
RESUMEN
Meniscal root tears have recently seen an increase in diagnosis. As we understand more about the biomechanical relationship between the meniscus and tibiofemoral articular surface, it becomes more important to promptly identify and repair these lesions. Root tears may cause up to a 25% increase in forces in the tibiofemoral compartment, potentially leading to hastened degenerative changes visible on radiographs and decreased patient outcomes. The anatomic footprint of the meniscal roots has been described, as well as multiple iterations of repair techniques, with the most popular being the arthroscopic-assisted transtibial pullout technique for repair of the posterior meniscal roots. The tensioning technique varies and has been a surgical step that can lead to error during the procedure. We use a transtibial technique with modifications in the method of suture fixation and tensioning. To begin, we use 2 doubled-over sutures that are passed through the root to create a looped end and a twin-tailed end. This is followed by the use of a locking, tensionable and, if needed, reversible Nice knot that is tied on the anterior tibial cortex over a button. This technique provides controlled and accurate tension to the root repair when tied over a suture button on the anterior tibia with stable suture fixation to root.
RESUMEN
To identify successes in improving America's health, we identified disease categories that appeared on vital statistics lists of leading causes of death in the US adult population in either 1950 or 2000, and that experienced at least a 50% reduction in age-adjusted death rates from their peak level to their lowest point between 1950 and 2000. Of the 9 cause-of-death categories that achieved this 50% reduction, literature review suggests that 7 clearly required diffusion of new innovations through both public health and medical care channels. Our nation's health success stories are consistent with a triangulation model of innovation plus public health plus medical care, even when the 3 sectors have worked more in parallel than in partnership.