Do Obese Patients Have Worse Outcomes in Adult Spinal Deformity Surgeries? A Meta-Analysis.

STUDY DESIGN: Meta-Analysis. OBJECTIVE: This meta-analysis evaluates the difference in surgical outcomes between obese and non-obese patients undergoing adult spinal deformity (ASD) corrective surgery. BACKGROUND: ASD encompasses a wide range of debilitating spinal abnormalities. Concurrently, obesity is on the rise globally and has been shown to influence the outcomes of ASD management. The relationship between obesity and surgical outcomes in ASD has been the focus of recent studies, yielding various results. METHODS: We conducted a comprehensive search of PubMed, Cochrane, and Google Scholar (page 1-20) through June of 2024. The surgical outcomes assessed included post-operative complications, revision rates, wound infections, thromboembolic events, implant-related complications, and non-home discharge. Surgical parameters such as operative time, length of stay (LOS), and estimated blood loss (EBL), as well as functional outcomes like the Oswestry Disability Index (ODI) and pain scores were analyzed. RESULTS: Nine studies met inclusion criteria. Non-obese patients exhibited a lower rate of implant-related complications (OR=0.25; 95% CI: 0.12-0.52, P=0.0002) and non-home discharge (OR=0.52; 95% CI: 0.32-0.84, P=0.007). Additionally, non-obese patients had reduced LOS (MD=-0.29; 95% CI: -0.53 - -0.05, P=0.02) and EBL (SMD=-0.68; 95% CI: -1.19 - -0.18, P=0.008). No statistically significant differences were observed for the remaining outcomes. CONCLUSION: Non-obese patients undergoing ASD corrective surgery are associated with fewer implant-related complications, a lower EBL, shorter LOS, and a higher likelihood of being discharged home compared to their obese counterparts.

Chronic Anticoagulation in Patients Who Have Atrial Fibrillation Undergoing Outpatient Total Knee Arthroplasty: A Retrospective Matched Cohort Study.

BACKGROUND: Patients who have atrial fibrillation frequently require long-term anticoagulation with warfarin or a direct-acting oral anticoagulant (DOAC), such as apixaban or rivaroxaban, to avoid vascular complications. However, the impact of anticoagulant use on postoperative complications following total knee arthroplasty (TKA) in an outpatient setting has not been thoroughly elucidated. The purpose of this study was to examine the impact of anticoagulant use on early postoperative complications among atrial fibrillation patients undergoing outpatient TKA. METHODS: An insurance claims database was queried to identify all patients who underwent outpatient TKA between January 2010 and April 2022. There were two cohorts of patients, with associated 1:1 matched controls, who had atrial fibrillation and filled a prescription of either warfarin (N = 4,396) or DOAC (N = 5,383) for at least 30 days. The mean age was 70 years (range, 51 to 84 years) and 47.9% were women in the warfarin cohort, while the mean age was 70 years and 49.2% were women in the DOAC cohort. Postoperative 30-day medical and 90-day surgical complications were subsequently compared. RESULTS: Patients on warfarin had a higher incidence of pulmonary embolism (1.1 versus 0.2%, P < 0.001) and a lower incidence of TKA revision (0.1 versus 0.4%, P = 0.003) than matched controls. Similarly, patients on DOACs exhibited a higher incidence of pneumonia (1.4 versus 0.6%, P < 0.001) and myocardial infarction (3.2 versus 1.5%, P < 0.001) and a lower incidence of wound dehiscence (0.1 versus 0.5%, P < 0.001), joint infection (0.4 versus 0.9%, P = 0.002), and TKA revision (0.1 versus 0.4%, P = 0.002) than matched controls. CONCLUSIONS: Atrial fibrillation patients on long-term anticoagulants undergoing outpatient TKA experience higher rates of medical complications and lower rates of surgical complications than matched controls. Thus, patients on long-term anticoagulants may be considered for outpatient TKA, but should be counseled appropriately on associated medical risks.

Osteoporosis in the setting of knee arthroplasty: a narrative review.

Patients undergoing knee replacement, which is mainly indicated in severe osteoarthritis, are frequently co-affected by osteoporosis and osteopenia. With a prevalence standing at around 20% in patients receiving knee arthroplasty, osteoporosis could lead to poor outcomes postoperatively. Some of these complications include periprosthetic fractures and an increased revision rate. Antiresorptive medications have been shown to be beneficial postoperatively. However, no studies have been conducted on whether they had any benefits if given preoperatively. Surgical management may also be beneficial, but this area remains full of controversy.

Enhanced Risk of 90-Day Medical and 2-Year Implant Related Complications in Total Shoulder Arthroplasty Patients with Osteoporosis.

BACKGROUND: As the average age of patients undergoing shoulder arthroplasty (SA) increases, the frequency of SA patients with osteoporosis is expected to rise. While the effects of osteoporosis have been described in the broader orthopedic literature, it is presently unclear how osteoporosis affects SA postoperative medical and implant-related outcomes. METHODS: A multicenter database TriNetX was queried for patients between 2011-2021 who underwent SA with and without osteoporosis. Patients with less than 2-years of follow-up and those with a prior shoulder hemiarthroplasty were excluded. Primary outcomes included 2-year periprosthetic joint infection (PJI), prosthesis dislocation, periprosthetic fracture, and revision surgery. Secondary outcomes included 90-day medical complications and readmissions. Osteoporotic and control patient cohorts were propensity matched in a 1:1 ratio. RESULTS: 7,842 patients were included after matching in each cohort. Baseline demographic variables were similar between groups, except osteoporotic patients had a lower BMI (28.6 vs 31.0 kg/m2; p < 0.001). Osteoporotic patients undergoing SA were more likely to experience wound disruptions, stroke, pulmonary embolism, deep vein thrombosis, myocardial infarction, anemia, pneumonia, renal failure, transfusion, and readmission within 90 days after surgery. At 2 years postoperative, osteoporotic SA patients experienced an elevated risk of mechanical loosening, PJI, dislocation, periprosthetic fracture, and required revision surgery at a higher rate than control patients. CONCLUSIONS: Osteoporotic patients undergoing shoulder arthroplasty are at greater risk for medical complications within the 90-day peri-operative period as well as implant-related complications within 2 years of surgery. Patients and surgeons should be aware of the potential higher risk of complications in osteoporotic patients following SA, and further investigation into benefits of preoperative management and treatment of osteoporosis is necessary.

Intraoperative Navigation in Reverse Shoulder Arthroplasty: Advantages and Future Prospects.

Intraoperative navigation is a novel technology that can provide real-time feedback to the surgeon during implantation and enhance the accuracy and precision of glenoid component positioning. Applications of intraoperative navigation systems have demonstrated increased precision in baseplate version and inclination, as well as improved baseplate screw placement, with fewer screws used and greater purchase length achieved when compared to standard instrumentation. Early clinical studies have shown favorable results, with significantly improved patient-reported and clinical outcomes and decreased complications. The implementation of intraoperative navigation is associated with a short learning curve and a minimal increase in operative time. Nevertheless, further research is necessary to substantiate the clinical benefit of navigation and evaluate its economic cost-effectiveness and impact on implant survival. Augmented reality and robotic-assisted surgery are additional emerging technologies that, while novel, hold the potential to further advance the field of shoulder arthroplasty.

Titanium Cages vs PEEK Cages in Interbody Fusions: A Meta-Analysis of Clinical and Radiographic Outcomes.

BACKGROUND: The most widely adopted materials for interbody fusion implants are titanium and polyetheretherketone (PEEK), both of which have their potential advantages and disadvantages. Despite the differences between PEEK and titanium, there is no consensus on which material provides better clinical and radiological outcomes. Therefore, the purpose of this meta-analysis is to analyze the clinical and radiographic outcomes between the two cages. METHODS: Four databases (PubMed, Cochrane, Embase and Google Scholar (page 1-20)) were queried since December 2001 up until December 2023,. The clinical outcomes evaluated included the rates of adverse events, radiographic outcomes, and PROs. RESULTS: Higher rates of subsidence and revision were reported in PEEK cages in the lumbar spine (p=0.0006, and p=0.006 respectively). In the cervical spine, no difference was observed between PEEK and titanium in any analysis. CONCLUSION: In the lumbar spine, titanium cages were shown to have a lower rate of subsidence and revision compared to PEEK. As for the cervical spine, the difference between cages did not reach statistical significance in any of the analyzed outcomes.

Impact of Segmental Lordosis Restoration During Degenerative Spinal Fusion on Two-Year Adjacent Segment Disease and Revision Rates.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Assess the impact of inadequate correction of L4-S1 lordosis during transforaminal lumber interbody fusion (TLIF) on adjacent segment disease and revision rates. BACKGROUND: Restoring alignment is an important consideration in spinal fusions. Failure to correct to level-specific alignment goals could promote the development of adjacent segment disease. As such, it is crucial to investigate the role of sagittal segmental alignment on clinical outcomes following short segment lumbar fusion. METHODS: Patients who underwent 1- to 3-level transforaminal lumbar interbody fusion (TLIF) and had two-year outcomes data were included in this retrospective cohort study. Segmental lumbar lordosis was assessed in all patients with L3-L4, L4-L5, and L5-S1 constructs. Demographics, radiographic spinopelvic alignment, and complications were compared in a sub-group of patients fused at L4-S1 with adequate (i.e., within 35-45°) and inadequate (i.e., <35°) L4-S1 lordosis. RESULTS: Among the 168 included patients, mean age was 61.7 years, 56.0% were female, and mean follow-up was 32.3 months. Segmental lumbar lordosis did not change significantly after TLIF of L3-L4, L4-L5, or L5-S1 (P>0.05). Two-year postoperatively, 32.7% developed adjacent segment disease and 19.6% underwent revisions. After stratification by adequate (N=15) or inadequate (N=54) restoration of L4-S1 lordosis following initial TLIF surgery, adequately-restored patients had higher preoperative L4-S1 lordosis (Adequately-Restored=39.3° vs Inadequately-Restored=29.5°, P<0.001) and lower two-year postoperative adjacent segment disease (6.7% vs. 33.3%, P=0.032) and revision (5.7% vs. 25.9%, P=0.l33) rates. Adjacent segment disease patients had higher implant-related complications (Adjacent Segment Disease=36.8% vs No Adjacent Segment Disease=8.0%, P=0.008) and subsequent revisions (61.1% vs. 8.7%, P<0.001). CONCLUSIONS: Adjacent segment disease and revisions after degenerative lumbar spinal fusion are common. In this cohort, suboptimal restoration of L4-S1 lordosis was associated with higher rates of adjacent segment disease and subsequent revisions, thus highlighting the importance of restoring sagittal alignment in degenerative spine surgery. LEVEL OF EVIDENCE: III.

Epidemiology of Lumbar Spine Fractures: Twenty-Year Assessment of Nationwide Emergency Department Visit Data.

BACKGROUND: Lumbar spine fractures are common injuries associated with substantial morbidity for patients and socioeconomic burden. This study sought to epidemiologically analyze lumbar spine fractures by mechanism of injury and identify temporal trends in patient demographics and disposition, which few studies have previously evaluated. MATERIALS AND METHODS: A retrospective analysis was done of the US National Electronic Injury Surveillance System (NEISS) database between 2003 and 2022. The sample contained all patients 2 to 101 years old with product-related lumbar fractures presenting to participating institutions' emergency departments. A total of 15,196 unweighted injuries (642,979 weighted injuries) were recorded. RESULTS: Overall, there was a 20-year incidence rate of 10.14 cases per 100,000 person-years with a 2-fold increase in fracture incidence. Females were more prone to lumbar fracture than males (P=.032). Injuries primarily stemmed from a fall (76.6%). The incidence of lumbar fracture increased most significantly in older patients, with patients 80 years and older showing the greatest annual increase (ß=8.771, R2=0.7439, P<.001) and patients 60 to 69 years showing the greatest percent increase with a 3.24-fold increase in incidence. Most (58.9%) of the fractures occurred at home. Females were more often injured at home compared with males (P<.001), who more often sustained lumbar fractures during recreational or athletic activity (P<.001). All patients older than 40 years showed at least a doubling in incidence rate of lumbar fracture between 2003 and 2022. CONCLUSION: These data demonstrate the pressing need to address poor bone health in the aging population, shown here to have an increasing fracture burden. [Orthopedics. 202x;4x(x):xx-xx.].

Spinal deformity surgery in Scheuermann's kyphosis versus adolescent idiopathic scoliosis: meta-analysis of complications and clinical outcomes.

BACKGROUND: Surgical management of adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) may be associated with several complications including extended length of stay and unplanned reoperations. Several studies have previously compared postoperative complications and functional outcomes for AIS and SK patients with mixed results. However, a meta-analysis compiling the literature on this topic is lacking. METHODS: Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until April 2024. The extracted data consisted of complications (overall and surgical-site infections [SSI]), readmissions, reoperations, and Scoliosis Research Society-22 (SRS-22) score. Mean differences (MD) with 95% CI were used for continuous data and odds ratio (OR) was utilized for dichotomous data were calculated across studies. RESULTS: Seven retrospective articles were included in the meta-analysis, including 4866 patients, with 399 in the SK group and 4467 in the AIS group. SK patients were found to have statistically significantly higher rates of overall complications (OR = 5.41; 95% CI 3.69-7.93, p < .001), SSI (OR = 11.30; 95% CI 6.14-20.82, p < .001), readmissions (OR = 2.81; 95% CI 1.21-6.53, p = 0.02), and reoperations (OR = 7.40; 95% CI 4.76-11.51, p < .001) than AIS patients. However, they had similar SRS-22 scores postoperatively (MD = -0.06; 95% CI -0.16 to 0.04, p = 0.26) despite the SK group having lower SRS-22 scores preoperatively (MD = -0.30; 95% CI -0.42 to -0.18, p < .001). CONCLUSION: In this meta-analysis of studies comparing spinal deformity surgery outcomes in AIS and SK patients, SK was associated with more complications, readmissions, and reoperations. SK did have equivalent SRS-22 scores postoperatively to AIS patients, highlighting the benefit of surgical treatment despite higher complication rates. This data may help inform healthcare institutions, payors, and quality monitoring organizations who examine outcomes of pediatric and adult spinal deformity surgery.

Postoperative Delirium Following Posterior Lumbar Spinal Fusion: Epidemiology, Risk Factors, and Associated Complications.

BACKGROUND: Postoperative delirium (POD) is frequently reported in the elderly after major surgery. Several risk factors have been identified, including age, surgical complexity, and comorbidities. METHODS: Posterior lumbar fusion patients were identified using PearlDiver and filtered into two cohorts based on the presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD by age and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analyzed. RESULTS: Among 476,482 no POD and 2591 POD patients, the mean age was 60.90 years, 57.6% were female, and the mean Charlson comorbidity index was 1.78. POD patients frequently had baseline cognitive impairment (P < 0.001). Incidence of POD decreased from 0.7% in 2010 to 0.4% in 2022 (P < 0.001) and increased with increasing patient age (P < 0.001). POD patients had higher length of stay (12 vs. 6 days, P < 0.001) and 90-day costs ($20,605 vs. $17,849, P < 0.001). After matching, POD patients had higher hypernatremia (5.8% vs. 3.5%, P = 0.001) and hypocalcemia (5.0% vs. 3.5%, P = 0.026). POD patients had higher 90-day postoperative complications (P < 0.05) than no POD patients. CONCLUSIONS: Nearly 0.5% of patients who underwent posterior spinal fusion between 2010 and 2022 developed delirium, although incidence rates have decreased over time. POD was common in elderly patients with electrolyte disturbances who underwent multilevel fusions. Patients suffering from POD had higher rates of 90-day postoperative complications. Ongoing efforts to deliver interventions to mitigate the consequences of POD among spine surgery patients are warranted.

The epidemiology of recreation-related cervical and thoracic fractures.

CONTEXT: Recreational activities are frequently associated with spinal fracture, yet contemporary characterization of sports-related cervical and thoracic fracture is lacking. PURPOSE: To characterize cervical and thoracic fractures associated with recreational activities. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: The National Electronic Injury Surveillance System (NEISS) database OUTCOME MEASURE AND COMPARISONS: Recreation-related cervical and thoracic fracture incidence rates per year, stratified by age and sex. Common causative activities were established by demographics. METHODS: The NEISS database was queried to identify patients with recreation-related cervical fractures between 2003 and 2022 and recreation-related thoracic fractures between 2003 and 2022 in patients aged >2 years-old. United States Census data was utilized to generate incidence rates per year. Data was stratified by demographic variables to assess the impact of age and sex on incidence and causative activity. RESULTS: Between 2003 and 2022, an estimated 13,823 recreation-related cervical fractures occurred with an average annual incidence of 2.20±0.35 per 1 million person-years, while 24,236 estimated recreation-related thoracic fractures occurred from 2003 to 2022 with an average incidence of 3.85±1.26. Males experienced a 3.51 times higher (95% CI 3.38-3.66) rate of cervical fracture, but thoracic fracture rates were similar between sexes. Individuals under 18 experienced a 2.15 times higher rate of thoracic fractures than those aged 18-64 (95% CI 1.85-2.50) and 1.93 times higher rate than those over 65 (95% CI 1.68-2.22). Recreation-related cervical fracture rates in individuals 18-64 was 1.186 (95% CI 1.14-1.23) times higher than those under 18 and rates in those under 18 were 1.15 (95% CI 1.09-1.22) times higher than those over 65. Football (26.6%), horseback riding (19.7%), and skiing (8.35%) were the primary causes of cervical fractures, and horseback riding (46.8%), football (11.2%), and skiing (10.3%) primarily caused thoracic fractures. Cervical fractures resulted primarily from football in males (24.7%) and horseback riding in females (44.0%). Horseback riding primarily caused thoracic fractures in both sexes (males=21.5%, females=74.7%). Football led causative activities for individuals under 18 (Cervical=42.4%, Thoracic=40.7%), while horseback riding dominated among those aged 18-64 (26.7%, 56.7%) and over 65 (52.8%, 67.9%). CONCLUSIONS: This investigation revealed epidemiological trends in cervical and thoracic spinal fractures and underscore the need for targeted preventive measures and safety interventions to mitigate the burden of these fractures particularly in horseback riding and American football. LEVEL OF EVIDENCE: Level III.

The Importance of Alignment in the Management of Thoracolumbar Trauma.

Spinal injuries occur in 3% of all patients with trauma, most commonly in males, and often as a result of high-velocity impact followed by abrupt deceleration. The most affected region after spinal trauma is the thoracolumbar junction because of the anterior center of gravity at the T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus nonoperative management of traumatic injuries at this site. However, the classifications do not consider the segmental alignment of the spine, an aspect that has been shown to improve quality of life in nontraumatic postoperative spinal patients. Ignoring this aspect of thoracolumbar management often contributes to the development of posttraumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the level of the injured vertebra, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to show the importance of segmental sagittal alignment and the vertebral level on patient outcomes.

Sagittal spinal alignment measurements and evaluation: Historical perspective.

Spinal alignment analysis play an important role in evaluating patients and planning surgical corrections for adult spinal deformity. The history of these parameters is relatively short with the first parameter, the Cobb angle, introduced in 1948 as part of an effort to improve scoliosis evaluation. New developments in the field were limited for nearly 30 years before better imaging technology encouraged new theories and later data about spinal alignment and the relationship between the spine and pelvis. These efforts would ultimately contribute to the creation of foundational spinal alignment parameters, including pelvic incidence, pelvic tilt, and sacral slope. By the 1990s, spinal alignment had become a sustained area of investigation for spinal surgeons and researchers. Novel alignment parameters have since been introduced as our knowledge has evolved and has allowed for valuable research that demonstrates the clinical and surgical value of alignment measurement. This manuscript will explore the history of spinal alignment analysis over the decades.

Rheumatoid arthritis is associated with higher 90-day systemic complications compared to osteoarthritis after total shoulder arthroplasty: a cohort study.

BACKGROUND: Total shoulder arthroplasty (TSA) in patients with rheumatoid arthritis (RA) can present unique challenges. The aim of this study was to compare both systemic and joint-related postoperative complications in patients undergoing primary TSA with RA versus those with primary osteoarthritis (OA). METHODS: Using the TriNetX database, Current Procedural Terminology and International Classification of Diseases, 10th edition codes were used to identify patients who underwent primary TSA. Patients were categorized into two cohorts: RA and OA. After 1:1 propensity score matching, postoperative systemic complications within 90 days following primary TSA and joint-related complications within 5 years following anatomic TSA (aTSA) and reverse shoulder arthroplasty (RSA) were compared. RESULTS: After propensity score matching, the RA and OA cohorts each consisted of 8,523 patients. Within 90 days postoperation, RA patients had a significantly higher risk of total complications, deep surgical site infection, wound dehiscence, pneumonia, myocardial infarction, acute renal failure, urinary tract infection, mortality, and readmission compared to the OA cohort. RA patients had a significantly greater risk of periprosthetic joint infection and prosthetic dislocation within 5 years following aTSA and RSA, and a greater risk of scapular fractures following RSA. Among RA patients, RSA had a significantly higher risk of prosthetic dislocation, scapular fractures, and revision compared to aTSA. CONCLUSIONS: Following TSA, RA patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary OA. Knowledge of the risk profile of RA patients undergoing TSA is essential for appropriate patient counseling and education. Level of evidence: III.

The impact of mental health on shoulder arthroplasty and rotator cuff repair: a meta-analysis.

BACKGROUND: The aim of this study was to evaluate the impact of mental health attributes, such as the presence of psychiatric comorbidities or psychological comorbidities (low resilience), on outcomes after rotator cuff repair (RCR) and total shoulder arthroplasty (TSA). METHODS: PubMed, Cochrane, and Google Scholar (results pages 1-20) were searched up to November 2023. Mental health problems of interest included the presence of psychiatric comorbidities (depression, anxiety) or indicators of poor psychological functioning, such as low resilience or the presence of distress. Patients were assigned to poor or good mental health groups in this study based on their grouping in the original study. RESULTS: Fourteen studies were included in the meta-analysis. Patients with good mental health had greater improvements in postoperative American Shoulder and Elbow Surgeons and Simple Shoulder Test scores in the TSA cohort (P=0.003 and P=0.01), RCR cohort (P<0.001), and the combined TSA and RCR cohort (P<0.001). No difference was found in visual analog scale score, satisfaction, external rotation, or flexion between the two mental health groups. Patients with poor mental health undergoing RCR experienced higher rates of adverse events and transfusions (P<0.001). Patients with poor mental health also had greater rates of revision and emergency department visits in the TSA cohort (P<0.001), RCR cohort (P=0.05 and P=0.03), and combined cohort (P<0.001). Patients with poor mental health undergoing TSA had a higher rate of re-admission (P<0.001). CONCLUSIONS: Patients with poor preoperative mental health showed inferior patient-reported outcome scores and increased rates of adverse events, revisions, and re-admissions. Level of evidence: III.

Hip Labral Repair versus Reconstruction: Meta-analysis.

The purpose of this meta-analysis is to compare the postoperative outcomes and complications of labral repair with those of labral reconstruction. An electronic search strategy was conducted from 1986 until August 2023 using the following databases: PubMed, Cochrane, and Google Scholar (pages 1-20). The primary objectives included the postoperative clinical outcomes determined by the number of patients who reached minimal clinical important difference (MCID) on the visual analog scale (VAS), modified Harris hip score (mHHS), Hip Outcome Score-Sports Subscale (HOS-SS), Hip Outcome Score-Activities of Daily Life (HOS-ADL), and International Hip Outcome Tool-12 (iHOT-12). In addition, analysis of the rate of revision arthroscopy, the rate of conversion to total hip arthroplasty (THA), the postoperative VAS, mHHS, HOS-SS, HOS-ADL, iHOT-12, nonarthritic hip score (NAHS), patient satisfaction, lower extremity function scale (LEFS), and the SF-12 (12-item shortform) was also performed. Any differences arising between the investigators were resolved by discussion. Seventeen studies were relevant to the inclusion criteria and were included in this meta-analysis. A higher rate of patients who reached MCID in the mHHS (P=0.02) as well as a higher rate of revision arthroscopy was observed for labral repair (P=0.03). The remaining studied outcomes were comparable. Despite the greater predictability of success in the reconstruction group, conduct of additional studies will be required for evaluation of the benefits of such findings. In addition, labral reconstruction is more technically demanding than a labral repair.

Patient-reported Physical and Mental Health Outcomes Following Lumbar Spinal Fusion versus Total Hip and Total Knee Replacement.

BACKGROUND: Total hip and knee arthroplasty (THA/TKA) are reliable surgical procedures for alleviating pain and optimizing function. Spinal fusion has also been shown to be beneficial, however the comparative benefit of THA/TKA to lumbar spinal fusion is incompletely understood. METHODS: This study analyzed a single-center database of patients who underwent primary lumbar spinal fusion, elective primary TKA, or THA. Patient-reported outcome measures (PROMs) included Veterans-Rand (VR12) Physical and Mental Component Score (PCS/MCS) for TKA/THA and PROMIS (Patient-Reported Outcomes Measurement Information System) Global Mental and Physical Health (GPH/GMH) for spinal fusion. RESULTS: A total of 356 patients who underwent TKA, 290 who underwent THA, and 125 who underwent spinal fusion were included. Joint replacement patients were older, with higher body mass index in the TKA group. Spine patients had a lower improvement in physical health than the joint patients (TKA: 9.4 ± 11.2, THA: 15.2 ± 11.2, Spine: 6.2 ± 8.7, P < 0.001) and a lower proportion of patients reaching the minimal clinically important difference (MCID). Spine patients had higher GMH improvements compared with TKA patients (TKA: -1.1 ± 10.7, THA: 1.1 ± 11.9, Spine: 1.8 ± 8.4, P = 0.009) and the highest proportion of patients reaching the MCID. CONCLUSIONS: Spinal fusion, total knee arthroplasty, and total hip arthroplasty all significantly improved PROMs at 1-year follow-up. At baseline, spinal fusion patients had better physical function scores and worse mental health scores compared with joint arthroplasty patients, while spinal fusion resulted in mean smaller gains in patient reported physical function and higher gains in patient reported mental health function compared with arthroplasty.

Impact of Prior Cervical Fusion on Patients Undergoing Thoracolumbar Deformity Correction.

STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: Evaluate the impact of prior cervical constructs on upper instrumented vertebrae (UIV) selection and postoperative outcomes among patients undergoing thoracolumbar deformity correction. BACKGROUND: Surgical planning for adult spinal deformity (ASD) patients involves consideration of spinal alignment and existing fusion constructs. METHODS: ASD patients with (ANTERIOR or POSTERIOR) and without (NONE) prior cervical fusion who underwent thoracolumbar fusion were included. Demographics, radiographic alignment, patient-reported outcome measures (PROMs), and complications were compared. Univariate and multivariate analyses were performed on POSTERIOR patients to identify parameters predictive of UIV choice and to evaluate postoperative outcomes impacted by UIV selection. RESULTS: Among 542 patients, with 446 NONE, 72 ANTERIOR, and 24 POSTERIOR patients, mean age was 64.4 years and 432 (80%) were female. Cervical fusion patients had worse preoperative cervical and lumbosacral deformity, and PROMs (P<0.05). In the POSTERIOR cohort, preoperative LIV was frequently below the cervicothoracic junction (54%) and uncommonly (13%) connected to the thoracolumbar UIV. Multivariate analyses revealed that higher preoperative cervical SVA (coeff=-0.22, 95%CI=-0.43--0.01, P=0.038) and C2SPi (coeff=-0.72, 95%CI=-1.36--0.07, P=0.031), and lower preoperative thoracic kyphosis (coeff=0.14, 95%CI=0.01-0.28, P=0.040) and thoracolumbar lordosis (coeff=0.22, 95%CI=0.10-0.33, P=0.001) were predictive of cranial UIV. Two-year postoperatively, cervical patients continued to have worse cervical deformity and PROMs (P<0.05) but had comparable postoperative complications. Choice of thoracolumbar UIV below or above T6, as well as the number of unfused levels between constructs, did not affect patient outcomes. CONCLUSIONS: Among patients who underwent thoracolumbar deformity correction, prior cervical fusion was associated with more severe spinopelvic deformity and PROMs preoperatively. The choice of thoracolumbar UIV was strongly predicted by their baseline cervical and thoracolumbar alignment. Despite their poor preoperative condition, these patients still experienced significant improvements in their thoracolumbar alignment and PROMs after surgery, irrespective of UIV selection. LEVEL OF EVIDENCE: IV.

The role of vitamin D in shoulder health: a comprehensive review of its impact on rotator cuff tears and surgical results.

Vitamin D deficiency is highly prevalent in the general population and is associated with various chronic health conditions. In addition to its role in bone mineralization, Vitamin D has various physiological effects that may impact the pathogenesis of shoulder pathologies. Vitamin D deficiency may also affect outcomes after shoulder surgeries, such as rotator cuff repair and total shoulder arthroplasty. Vitamin D plays a role in tissue healing, bone growth, and maintenance of homeostasis in skeletal muscle cells. Vitamin D also has anti-inflammatory effects that are important to rotator cuff health. Vitamin D deficiency is highly prevalent in patients with rotator cuff tears, suggesting its role as a potential risk factor. Vitamin D deficiency has been associated with decreased preoperative shoulder strength as well as increased re-tear rates, postoperative stiffness, and the need for revision surgery in patients who underwent rotator cuff repair. Studies have also demonstrated a potential association between vitamin D deficiency and increased risk of revision after total shoulder arthroplasty. Further research is necessary to elucidate the direct role of vitamin D in the pathogenesis of rotator cuff tears and its impact on clinical outcomes after rotator cuff surgery and total shoulder arthroplasty.