Femoral vein blood flow during a total hip arthroplasty using a modified Heuter approach.

Several modifications to traditional surgical approaches for total hip arthroplasty (THA) have been introduced in an attempt to improve upon minimally invasive approaches and enhance short-term recovery. However, minimally invasive approaches are not without risk, including that of postoperative venous thromboembolism (VTE). There has been no published literature evaluating the femoral vein during an anterior approach. We aimed to study femoral vein blood flow using duplex ultrasonography during THA performed through a modified Heuter approach. Peek flow and vessel cross-sectional area were affected by limb position as well as acetabular and femoral retractor placement. No VTE was observed, but there was observed femoral vein compression, which may represent a risk of postoperative VTE similar to that seen in standard surgical approaches for THA.

The Effect of BMI on 30 Day Outcomes Following Total Joint Arthroplasty.

Hip and knee arthroplasty (THA, TKA) are safe, effective procedures with reliable, reproducible outcomes. We aim to investigate obesity's effect on complications following arthroplasty surgery. Using the American College of Surgeons-National Surgical Quality Improvement Program database, 13,250 subjects were stratified into 5 groups based on BMI and matched for gender, age, surgery type and ASA class. Matched, multivariable generalized linear models adjusting for demographics and comorbidities demonstrated an association between elevated BMI and overall (P<0.001), medical (P=0.005), surgical complications (P<0.001), including superficial (P=0.019) and deep wound infection (P=0.040), return to OR (P=0.016) and time from OR to discharge (P=0.003). Elevated BMI increases risk for post-operative complications following total joint arthroplasty.

Outcomes of Tibial Derotational Osteotomies Performed in Patients With Myelodysplasia.

BACKGROUND: Rotational deformities of the tibia are common in patients with myelodysplasia. The current recommended treatment is tibial derotational osteotomy to improve gait biomechanics. Previously reported complication rates are widely variable. The purpose of this study is to review the outcomes of derotational osteotomies as a function of complication and revision surgery rates as compared with previous studies. METHODS: A retrospective chart review was performed on all tibial derotational osteotomies performed in patients with myelodysplasia from 1985 to 2010 in patients older than 5 years with > 2 years of follow-up. Charts were reviewed for demographics, amount of derotation at index surgery, incidence of complications, and the need for repeat derotational surgery. Descriptive statistics were used to determine the incidence of complications as well as need for reoperation. Further analysis was performed using Fisher Exact Test and the Student t test to identify independent risk factors for complication and rerotation. RESULTS: Eighty-two patients (129 limbs) had sufficient data for inclusion. The average follow-up was 7.15 years. Surgery was indicated for symptomatic torsion measuring > 20 degrees. The average amount of derotation was 28 ± 12 degrees. The incidence of complications was 10.85%, with a 3.10% incidence of major complications including fracture, deep infection, and hardware failure. The repeat derotation rate was 16.28%, all in patients initially treated for external tibial torsion. Age at initial surgery had no effect on complication rate or need for reoperation. Level of spinal involvement was not associated with complication risk; however, lumbar-level involvement was an independent risk factor for rerotation. CONCLUSIONS: With meticulous operative technique, derotational osteotomy of the tibia in patients with myelomeningocele remains a safe and effective method to treat tibial torsion, with an acceptable overall complication rate of 10.85% and a major complication rate of 3.10%. The data presented will aid providers in appropriate counseling of patients considering tibial derotational osteotomy.

Factors Affecting Readmission Rates Following Primary Total Hip Arthroplasty.

BACKGROUND: Readmissions following total hip arthroplasty are a focus given the forthcoming financial penalties that hospitals in the United States may incur starting in 2015. The purpose of this study was to identify both preoperative comorbidities and postoperative conditions that increase the risk of readmission following total hip arthroplasty. METHODS: Using the American College of Surgeons-National Surgical Quality Improvement Program data for 2011, a study population was identified using the Current Procedural Terminology code for primary total hip arthroplasty (27130). The sample was stratified into readmitted and non-readmitted cohorts. Demographic variables, preoperative comorbidities, laboratory values, operative characteristics, and surgical outcomes were compared between the groups using univariate and multivariate logistic regression models. RESULTS: Of the 9441 patients, there were 345 readmissions (3.65%) within the first thirty days following surgery. Comorbidities that increased the risk for readmission were diabetes (p < 0.001), chronic obstructive pulmonary disease (p < 0.001), bleeding disorders (p < 0.001), preoperative blood transfusion (p = 0.035), corticosteroid use (p < 0.001), dyspnea (p = 0.001), previous cardiac surgery (p = 0.002), and hypertension (p < 0.001). A multivariate regression model was used to control for potential confounders. Having a body mass index of ≥40 kg/m2 (odds ratio, 1.941 [95% confidence interval, 1.019 to 3.696]; p = 0.044) and using corticosteroids preoperatively (odds ratio, 2.928 [95% confidence interval, 1.731 to 4.953]; p < 0.001) were independently associated with a higher likelihood of readmission, and a high preoperative serum albumin (odds ratio, 0.688 [95% confidence interval, 0.477 to 0.992]; p = 0.045) was independently associated with a lower risk for readmission. Postoperative surgical site infection, pulmonary embolism, deep venous thrombosis, and sepsis (p < 0.001) were also independent risk factors for readmission. CONCLUSIONS: The risk of readmission following total hip arthroplasty increases with growing preoperative comorbidity burden, and is specifically increased in patients with a body mass index of ≥40 kg/m2, a history of corticosteroid use, and low preoperative serum albumin and in patients with postoperative surgical site infection, a thromboembolic event, and sepsis. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Compliance with immunizations in splenectomized individuals with hereditary spherocytosis.

Overwhelming infection by encapsulated bacteria is a significant risk of splenectomy. Strict adherence to immunizations against encapsulated organisms is recommended. We performed a cross-sectional study to determine immunization status after splenectomy in the hereditary spherocytosis (HS) population. As HS is most often autosomal dominant, we used a strategy of ascertaining older affected individuals by expanding pedigrees from patients in our pediatric hematology center. Only 26% of asplenic patients reported receiving all recommended post-splenectomy vaccines. This study demonstrates that pediatric hematology clinics have a unique opportunity to provide or recommend catch-up and booster vaccinations to splenectomized adult relatives of their patients.