Six-Item Modified Frailty Index independently predicts complications following total shoulder arthroplasty.

Background: In the realm of orthopedic surgery, frailty has been associated with higher rates of complications following total hip and total knee arthroplasties. Among various measures of frailty, the Six-Item Modified Frailty Index (MF-6) has recently gained popularity as a predictor for postoperative complications. The purpose of this study was to investigate MF-6 as a predictor for early postoperative complications in the elderly patient population following total shoulder arthroplasty (TSA). Methods: The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients who underwent TSA between 2015 and 2020. Patient demographics and comorbidities were compared between cohorts using bivariate logistic regression analysis. Multivariate logistic regression, adjusted for all significantly associated patient demographics and comorbidities, was used to identify associations between the MF-6 score and postoperative complications. Results: Of total, 9228 patients were included in this study: 8764 (95.0%) had MF-6 <3, and 464 (5.0%) patients had MF-6 ≥3. Multivariate analysis found MF-6 ≥3 to be independently associated with higher rates of urinary tract infection (odds ratio [OR]: 2.79, 95% confidence interval [CI]: 1.49-5.23; P = .001), blood transfusion (OR: 1.53, 95% CI: 1.01-2.32; P = .045), readmission (OR: 1.58, 95% CI: 1.06-2.35; P = .024), and non-home discharge (OR: 2.60, 95% CI: 2.08-3.25; P < .001). Conclusion: A high MF-6 score (≥3) in patients aged 65 and older is independently associated with higher rates of urinary tract infection, blood transfusion, readmission, and non-home discharge following TSA. The MF-6 score can be easily calculated preoperatively and may allow for better preoperative risk stratification.

Hypertension and postoperative complications following arthroscopic rotator cuff repair.

Background: The purpose of this study was to investigate the relationship between hypertension and postoperative complications following arthroscopic rotator cuff repair (aRCR). Methods: The American College of Surgeons National Surgical Quality Improvement Program database was surveyed for all patients who underwent aRCR between 2015 and 2021. Patient demographics, comorbidities, and 30-day postoperative complication data were analyzed. Multivariate logistic regression identified postoperative complications associated with hypertension. Results: Forty-six thousand five hundred and sixty-two patients were included in the analysis: 20,999 (45.1%) patients in the hypertensive cohort and 25,563 (54.9%) in the nonhypertensive cohort. Hypertension was associated with male gender (P < .001), age ≥ 65 years (P < .001), body mass index > 30 (P < .001), dependent functional status (P < .001), American Society of Anesthesiologists classification ≥ 3 (P < .001), current smoker (P < .001), diabetes (P < .001), chronic obstructive pulmonary disease (P < .001), and bleeding disorders (P < .001). Thrity-day postoperative complications significantly associated with hypertension included pneumonia (P = .012), reintubation (P = .009), urinary tract infection (P = .002), stroke (P = .044), myocardial infarction (P = .004), ventilator > 48 hours (P = .017), readmission (P < .001), non-home discharge (P < .001), and mortality (P = .020). After adjusting for patient demographics and comorbidities, readmission (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.13-1.75; P = .002) was independently associated with hypertension. Conclusion: Hypertension was identified as a risk factor for various postoperative complications following aRCR. Hypertension was found to be an independent predictor for readmission following aRCR.

Pelvic index: A new pelvic parameter for assessing sagittal spinal alignment.

Background: The incidence of correctional surgery for adult spinal deformity (ASD) has increased significantly over the past 2 decades. Pelvic incidence, an angular measurement, is the gold standard pelvic parameter and is used to classify spinal shapes into Roussouly types. Current literature states that restoration of the spine to its original Roussouly classification optimizes outcomes. We propose a new pelvic parameter, pelvic index, as a length measurement to complement pelvic incidence in more accurately characterizing Roussouly types. Methods: This study is a retrospective evaluation of sagittal spinal radiographs of 208 patients who were assessed by a single fellowship trained orthopedic spine surgeon between January and December 2020. Measurements included pelvic incidence, sacroacetabular distance, and L5 vertebral height. Pelvic index was calculated as the ratio of sacroacetabular distance to L5 height. Each spine was also classified into one of the Roussouly types: 1, 2, 3 anteverted pelvis (AP), 3, or 4. The 2 pelvic parameters were compared between groups to assess their ability to differentiate between Roussouly types. Results: Of the 208 patients included, 103 (49.5%) were female and 105 (50.5%) were male. The mean pelvic incidence was 54.9 ± 12.3° and the mean pelvic index was 3.99 ± 0.38. The difference in mean pelvic index was statistically significant between types 1 and 2 (0.15; p=.046) and between types 1 and 3 AP (0.19; p=.029). It was not statistically significant between types 3 and 4 (0.05; p=.251). However, in terms of pelvic incidence, the mean difference was statistically significant only between types 3 and 4 (10.4; p<.001). Conclusions: Pelvic index is the ratio of the sacroacetabular distance to the height of the L5 vertebra. In conjunction with pelvic incidence, pelvic index can help to distinguish between Roussouly types 1 and 2 and between types 1 and 3 AP, the low-pelvic incidence types.

Epidemiologic patterns of adolescent idiopathic scoliosis detection and treatment in new york state.

The purpose of this study is to examine the epidemiologic trends of adolescent idiopathic scoliosis (AIS) detection and treatment in New York State (NYS), including disparities in access. The New York Statewide Planning and Research Cooperative System database was reviewed to identify patients who underwent treatment for, or were diagnosed with, AIS from 2008 to 2016. Age determined adolescence; and the surgery date, 3-digit zip code, sex, race, insurance status, institution and surgeon license number were recorded to identify such trends. The geographical distribution was assembled from an NYS shapefile, obtained from the Topologically Integrated Geographic Encoding and Referencing database with analysis performed using tigris R. In total 54 002 patients with AIS, 3967 of whom were surgically treated, were identified for analysis. Diagnoses spiked in 2010. Females were diagnosed and underwent surgical treatment more frequently than males. AIS was diagnosed and treated in white patients more frequently than in black and Asian patients combined. From 2010 to 2013, the patients self-paying for surgical treatment decreased more than other payment modalities. Medium-volume surgeons continually increased the number of cases performed, whereas low-volume surgeons exhibited the opposite pattern. High-volume hospitals had a decrease in the number of cases from 2012 and were overtaken by medium-volume hospitals in 2015. Most procedures are performed within the New York City (NYC) area, though AIS was common in all NYS counties. AIS diagnoses increased after 2010, with fewer patients self-paying for surgery. White patients underwent more procedures than minority patients. Surgical cases were disproportionally performed in the NYC area compared to statewide.

Leupeptin accelerates recovery after sciatic transection and repair, but not crush injuries in rats.

We aimed to explore previously reported discrepancies in success with leupeptin by comparing outcomes of two types of injury: transection and crush. Male rats were randomized into vehicle and leupeptin treatment groups (n = 6/transection group; n = 10/crush group). Leupeptin (12 mg/kg) was administered via intramuscular injection into the gastrocnemius muscle twice a week for the duration of the study. Rats were monitored on a weekly basis for electromyographic function and gait for 8 weeks. A total of 83.3% of the rats that were treated with leupeptin began to recover electromyographic activity 1 week after transection, versus 0% that were treated with leupeptin after crush (P < 0.0001). Rats that were treated with leupeptin also had less functional debilitation, as indicated by a greater sciatic functional index at five of the eight time-points after transection versus one of eight after crush (P ≤ 0.05). Leupeptin aids in the rate of recovery after transection and repair but not crush injuries. These findings suggest there may be differences in pathology and recovery associated with these two types of peripheral nerve injury.

Inflammatory Myofibroblastic Tumor 12 Years After Treatment for Synovial Sarcoma: A Case Report.

Inflammatory myofibroblastic tumors (IMTs) are mesenchymal neoplasms most seen in the abdominopelvic region, lung, and retroperitoneum; and less commonly seen in virtually any other site. We report a case of two lower limb masses consistent with diagnosis of IMTs. This is a 39-year-old woman with a history of right lower extremity popliteal fossa synovial sarcoma diagnosed 12 years prior and treated with chemotherapy, surgery, and radiation. She presented with two new - one anterior and one posterior - right thigh masses. Biopsies of the lesions demonstrated low-grade inflammatory spindle cell lesions at both sites. Wide resection was performed for both masses and further characterization of the surgical specimens was most consistent with IMT. At follow-up, the patient is well with no signs of recurrence 19 and 7 months postoperative to the resection of the anterior and posterior thigh masses, respectively. This case represents the first reported IMTs occurring as late as 12 years after primary cancer treatment, and the first occurring after synovial sarcoma.

PET/MRI reveals ongoing metabolic activity in ACL grafts one year post-ACL reconstruction.

PURPOSE: To use serial PET/MRI imaging to radiographically evaluate the metabolic activity of the ACL graft over the first post-operative year. METHODS: Six patients undergoing primary ACL reconstruction were recruited in this prospective study in an inpatient university hospital. All patients underwent femoral and tibial suspensory cortical fixation with quadrupled semitendinosus autograft hamstring ACL reconstruction by an orthopaedic surgeon. Simultaneous 18F-FDG PET and MRI of both the operative and non-operative knee was performed at three, six, and 12 months post-operatively. Quantification of the mean standardized uptake value (SUV) within the whole-knee, as well as tibial tunnel, femoral tunnel, and intra-articular graft regions of interest (ROIs). RESULTS: PET whole-knee activity was increased at all time-points post-operatively compared to the control, non-operative knee. Activity decreased over time, yet considerable generalized activity remained 1 year post-operatively, with relative intensity 34% percent higher than control. When the operative knee was divided into three whole-regions, there was greater activity in the tibia at three than 12 months, the femur at six than 12 months, and in the tibia compared to the intra-articular region at 3 months. When they were separated into sub-regions, results demonstrated greater activity closer to the joint surface. CONCLUSIONS: PET/MRI evaluation of ACL graft reconstructions demonstrates evolving biologic activity within the graft and both tunnels. Focal areas of increased activity within the tunnels may indicate of ligamento-osseous morphologic changes. These data suggest that graft incorporation continues well beyond 1 year post-operatively. LEVEL OF EVIDENCE: Level IV.