Proximal Junctional Kyphosis in Degenerative Sagittal Deformity After Under- and Overcorrection of Lumbar Lordosis: Does Overcorrection of Lumbar Lordosis Instigate PJK?

STUDY DESIGN: Retrospective study. OBJECTIVE: To analyze proximal junctional kyphosis (PJK) occurrence and surgical outcomes according to degree of lumbar lordosis (LL) correction relative to pelvic incidence (PI). In addition, risk factors of PJK including LL and sagittal vertical axis (SVA) correction were investigated. SUMMARY OF BACKGROUND DATA: PJK is a common complication after adult spinal deformity surgery, and many factors are known to be associated with PJK. However, the effect of degree of LL correction on PJK occurrence is not fully understood. METHODS: Eighty-three degenerative sagittal imbalance patients treated with deformity correction and long instrumented fusion to the sacrum with a minimum follow-up of 2 years were studied. Patients were divided into three groups according to their postoperative LL angle relative to PI using the SRS-Schwab classification: Group A (undercorrection, PI-LL> 10°), Group B (ideal correction, -10°

Hematologic profile in reverse total shoulder arthroplasty: perioperative and postoperative blood loss.

BACKGROUND: Few studies have investigated the amount of blood loss during reverse total shoulder arthroplasty (RTSA). The purpose of this study was to investigate blood loss in patients who underwent RTSA for massive irreparable rotator cuff tear (MIRCT) using the hemoglobin (Hb) balance method and total Hemovac amount and to identify predictors of blood transfusion in these patients. METHODS: We retrospectively reviewed 121 patients who underwent RTSA for MIRCT. The mean age was 71.2 ± 6.9 years, and 75 were women. Age, sex, body mass index, use of anticoagulants, American Society of Anesthesiologists physical status score, comorbidities (eg, hypertension, diabetes mellitus, cerebrovascular accident), preoperative Hb level, preoperative hematocrit level, preoperative prothrombin time/international normalized ratio, use of cement, and operative time were evaluated as values predicting blood transfusion. RESULTS: The overall blood loss was 846.6 ± 527.6 mL, which included 346 ± 231.2 mL of intraoperative blood loss and 500.3 ± 196.4 mL of postoperative blood loss. Values predicting blood transfusion were a lower preoperative Hb level (P < .001), hematocrit level (P < .001), hypertension (P = .018), and cerebrovascular accident (P = .008). Receiver operating characteristic analysis identified the following cutoff values for predicting transfusion: preoperative Hb level of 13.5 g/dL (90.3% sensitivity) and hematocrit of 40% (90.3% sensitivity). CONCLUSIONS: RTSA for MIRCT is associated with blood loss during and after surgery. The amount of blood loss should be noted, and blood transfusion could be predicted by calculating the blood loss and predictive values. Lower preoperative Hb level, hematocrit, hypertension, and cerebrovascular accident are predictors of blood transfusion. Blood transfusion should be considered if a patient with preoperative Hb level <13.5 g/dL and hematocrit <40% has a history of hypertension or cerebrovascular accident.

Comparison of Clinical Results and Injury Risk of Posterior Tibial Cortex Between Attune and Press Fit Condylar Sigma Knee Systems.

BACKGROUND: We compared clinical and radiographic results after total knee arthroplasty (TKA) using Attune and Press Fit Condylar Sigma, and investigated whether use of the current prosthesis increased injury risk to the tibial cortex in Asian patients. We also assessed whether a preoperative posterior tibial slope angle (PSA) is associated with the injury when using the current prosthesis. METHODS: The 300 TKAs with Attune (group A) were compared to the 300 TKAs with Press Fit Condylar Sigma (group B). Demographics were not different, except follow-up periods (24.8 vs 33.3 months, P < .001). The Western Ontario and McMaster Universities Index and range of motion were compared. A minimum distance between tibial component stem and posterior tibial cortex (mDSC) was compared. The correlation between preoperative PSA and mDSC was analyzed in group A. RESULTS: The postoperative Western Ontario and McMaster Universities Index and range of motion of group A were better than those of group B (17.7 vs 18.8, P = .004; 131.4° vs 129.0°, P = .008). The mDSC was shorter in group A (6.3 vs 7.0 mm, P < .001), which made up a higher proportion of the high-risk group for posterior tibial cortical injury with an mDSC of <4 mm (20.0% vs 10.7%, P = .002). A negative correlation was found between the preoperative PSA and mDSC in group A (r = -0.205, P < .001). CONCLUSION: The TKA using the current prosthesis provided more satisfactory results than the TKA using the previous prosthesis. However, the injury risk to the posterior tibial cortex increased in the knees with a large PSA when using the current prosthesis for Asian patients.