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Morriss N, Brophy RH. Diabetes in Orthopaedic Sports Medicine Surgeries Standard Review. J Am Acad Orthop Surg 2024; 32:51-58. [PMID: 37755401 DOI: 10.5435/jaaos-d-22-01112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/20/2023] [Indexed: 09/28/2023] Open
Abstract
Diabetes mellitus has been shown to affect the outcomes of various orthopaedic procedures. Although orthopaedic sports medicine procedures tend to be less invasive and are often performed on younger and healthier patients, diabetes is associated with an increased risk of postoperative infection, readmission, and lower functional outcome scores. However, this risk may be moderated by the glycemic control of the individual patient, and patients with a low perioperative hemoglobin A1c may not confer additional risk. Further research is needed to evaluate the impact of diabetes on surgical outcomes in sports orthopaedics is needed, with the goal of evaluating mediating factors such as glycemic control in mind.
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Affiliation(s)
- Nicholas Morriss
- From the Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
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Schaver AL, Lash JG, MacAskill ML, Taylor S, Hewett TE, Jasko JJ, Argintar EH, Lavender CD. Partial meniscectomy using needle arthroscopy associated with significantly less pain and improved patient reported outcomes at two weeks after surgery: A comparison to standard knee arthroscopy. J Orthop 2023; 41:63-66. [PMID: 37538832 PMCID: PMC10393789 DOI: 10.1016/j.jor.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023] Open
Abstract
Purpose to compare immediate post-operative pain and patient-reported outcomes (PROs) after partial meniscectomy with needle (NA) vs. standard (SA) arthroscopy technique. Methods A retrospective review of a consecutive series of patients who underwent partial meniscectomy before and after adoption of a needle arthroscopic technique was performed. Meniscus repairs, root repairs, and those with ligamentous injuries were excluded. Total milligram morphine equivalents (MMEs) consumed, Visual analog scale (VAS) pain, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were compared pre-operatively and at 2 and 6-weeks postoperatively. Univariate analysis was used to compare results. Results Nineteen patients were in each group (NA: 10 females, SA: 11 females). Mean ± SD age (NA 42.8 ± 8.4 vs. SA 47.6 ± 10.4 years, p = 0.13) and body mass index (NA 31.4 ± 5.6 vs. SA 35.1 ± 5.4 m/kg2, p = 0.06) were not significantly different. Seventeen (89%) patients in both groups had medial meniscus tears of the posterior horn. Preoperative Outerbridge score was significantly greater in the SA group (3.4 vs. 1.8, p = 0.002); however, preoperative VAS pain (NA 6.1 ± 1.7 vs. SA 6.1 ± 1.8, p = 0.98) and KOOS pain (NA 44 ± 17% vs. SA 37 ± 12.5%, p = 0.20) were similar. Amount of arthroscopic fluid used was significantly greater in the SA vs. NA group (1.4 ± 0.7 vs. 0.5 ± 0.3 L, p < 0.0001), but tourniquet time was equivalent (NA 20 ± 6 vs.16 ± 6 min, p = 0.11). VAS pain scores (NA 1.0 ± 1.1 vs. SA 2.6 ± 1.5, p = 0.0014), KOOS pain (NA 79 ± 15% vs. 58 ± 19%, p = 0.0006), and Quality of Life (QOL) scores (NA 70 ± 22% vs. SA 43 ± 24%, p = 0.001) were significantly better at 2-weeks post-op in the N group. By 6 weeks post-op, all PROs including VAS pain and KOOS scores were similar between groups. Conclusions Adoption of a needle arthroscopic technique for partial meniscectomy was associated with significantly improved VAS and KOOS pain scores two-weeks post-operatively. Differences were not sustained at 6 weeks after surgery. Level of evidence III, Retrospective Comparison Study.
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Affiliation(s)
- Andrew L. Schaver
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Jonathan G. Lash
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Micah L. MacAskill
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Shane Taylor
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Timothy E. Hewett
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - John J. Jasko
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
| | - Evan H. Argintar
- MedStar Orthopaedic Institute, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
| | - Chad D. Lavender
- Marshall University, Department of Orthopedic Surgery, 1600 Medical Center Dr., Huntington, WV, 25701, USA
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Teissier V, Pujol N. Unplanned return to the operating room after arthroscopic procedures: a need to consider 12 months after the initial surgery. Arch Orthop Trauma Surg 2023; 143:2055-2062. [PMID: 35778529 DOI: 10.1007/s00402-022-04522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study was to report the proportion and cause of unplanned revision surgery rates within 1 year following arthroscopic procedures. Our hypothesis was that there is a significant rate of unplanned returns (URs) occurring between 3 and 12 months after the initial procedure and that causes of revision are different when considering the delay after the index surgery. MATERIALS AND METHODS Among 4142 consecutive patients who underwent an arthroscopic procedure in a single department of orthopedics and traumatology, patients undergoing revision surgery for any reasons directly related to the primary procedure were included. Cause for revision, surgical site, delay from index procedure, and number of revisions were screened. RESULTS Seventy-eight patients underwent 97 revision surgeries (2.3%) for reasons directly related to the primary procedure. Most revision surgeries were performed after month 3 following index surgery (59 patients, 60.8%). Mean time to revision surgery was 5.3 ± 4.3 months (range 0-365 days). Usual early-onset (< 3 months) reasons for unplanned revision were surgical site infection (17 patients, 0.41%), wound-healing defect (12 patients, 0.29%), and hemorrhagic complication (7 patients, 0.17%). Reasons for delayed unplanned revision (> 3 months) were index procedure failure (21 patients, 0.51%), stiffness (18 patients, 0.43%), and removal of hardware (16 patients, 0.41%). CONCLUSIONS Reasons for return to the operating room (OR) are different depending on the timepoint from index procedure. Patients should receive relevant information accordingly when scheduling any arthroscopic procedure, including up to 1-year potential complications. LEVEL OF EVIDENCE Prognostic study, Case series, Level IV.
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Affiliation(s)
- Victoria Teissier
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Nicolas Pujol
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France.
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Corticosteroid injections 2 months before arthroscopic meniscectomy increases the rate of postoperative infections requiring surgical irrigation and debridement. Knee Surg Sports Traumatol Arthrosc 2022; 30:3796-3804. [PMID: 35622120 DOI: 10.1007/s00167-022-06981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Consensus guidelines recommend administering a corticosteroid injection (CSI) for patients with a symptomatic degenerative meniscus lesion prior to arthroscopic partial meniscectomy (APM). A recent study found that CSI administered within 1 month prior to meniscectomy is associated with an increased risk of postoperative infection. However, infections may range in severity from superficial infections to serious infections requiring surgical interventions. The aim of this analysis was to define the rate of infections requiring surgery after APM and determine its relationship to preoperative CSI. METHODS The PearlDiver Mariner administrative claims database was queried for patients > 35 years old who had a CSI in the year prior to isolated APM. Rates of deep infection and infection requiring surgery within 6 months were reported between matched patients with a CSI and no injection. RESULTS After matching, there were 16,009 patients per group with a mean age of 59.4 years (SD = 9.6), 53.5% obesity, and 40% male. Forty-four of 113 patients who developed a postoperative deep infection went on to have a reoperation for irrigation and/or debridement (0.1% of all APM). Of these 44 patients, 30 had a preoperative CSI and 14 were controls unadjusted odds ratio (unadj-OR) if given CSI = 1.95, 95% CI 1.03-3.68, P = 0.04). Having a CSI within the month before surgery conferred a 4.56-fold increase in odds of an infection warranting surgery (95% CI 1.96-10.21, P < 0.01), whilst having a CSI 4-8 weeks before surgery conferred a 2.42-fold increase in odds (95% CI 1.04-5.42, P = 0.03). Receiving multiple CSI in the year prior to APM was associated with 5.27-fold increased odds of an infection requiring surgery (95% CI 1.19-23.27, P = 0.03), compared to having a single CSI. CONCLUSIONS Serious infections requiring a surgical intervention are rare after a meniscectomy, occurring in 0.1% of APMs in a matched cohort of patients over 35. Patients were five times more likely to return to the operating room for infection after APM if they had a CSI in the month before or had multiple CSIs in the year before surgery. The risk of infection was no longer significant if there was at least a 2-month interval between preoperative CSI and APM. LEVEL OF EVIDENCE Level III.
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Williams C, Bagwell MT, DeDeo M, Lutz AB, Deal MJ, Richey BP, Zeini IM, Service B, Youmans DH, Osbahr DC. Demographics and surgery-related complications lead to 30-day readmission rates among knee arthroscopic procedures. Knee Surg Sports Traumatol Arthrosc 2022; 30:2408-2418. [PMID: 35199185 DOI: 10.1007/s00167-022-06919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The study objectives were (1) to evaluate risk factors related to 30-day hospital readmissions after arthroscopic knee surgeries and (2) to determine the complications that may arise from surgery. METHODS The American College of Surgeons National Surgical Quality Improvement Program database data from 2012 to 2017 were researched. Patients were identified using Current Procedural Terminology codes for knee arthroscopic procedures. Ordinal logistic fit regression and decision tree analysis were used to examine study objectives. RESULTS There were 83,083 knee arthroscopic procedures between 2012 and 2017 obtained from the National Surgical Quality Improvement Program database. The overall readmission rate was 0.87%. The complication rates were highest for synovectomy and cartilage procedures, 1.6% and 1.3% respectively. A majority of readmissions were related to the procedure (71.1%) with wound complications being the primary reason (28.2%) followed by pulmonary embolism and deep vein thrombosis, 12.7% and 10.6%, respectively. Gender and body mass index were not significant factors and age over 65 years was an independent risk factor. Wound infection, deep vein thrombosis, and pulmonary embolism were the most prevalent complications. CONCLUSION Healthcare professionals have a unique opportunity to modify treatment plans based on patient risk factors. For patients who are at higher risk of inferior surgical outcomes, clinicians should carefully weigh risk factors when considering surgical and non-surgical approaches. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cynthia Williams
- Department of Health Administration, Brooks College of Health, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224-2646, USA
| | - Matt T Bagwell
- Department of Public Administration, School of Criminology, Criminal Justice and Public Administration, College of Liberal and Fine Arts, Tarleton State University, 10850 Texan Rider Dr., Rm # 336, Fort Worth, TX, 76036-9414, USA.
| | - Michelle DeDeo
- Department of Mathematics and Statistics, College of Arts and Sciences, University of North Florida, 1 UNF Drive, Jacksonville, FL, 32224-2646, USA
| | - Alexandra Baker Lutz
- Department of Orthopedic Surgery, University of Maryland, 110 S Paca St, Baltimore, MD, 21201, USA
| | - M Jordan Deal
- Department of Orthopedic Surgery, William Beaumont Hospital, Royal Oak, 3577 W.13 Mile Rd., Suite 402, Royal Oak, MI, 48073, USA
| | - Bradley P Richey
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd 32827, Orlando, FL, USA
| | - Ibrahim M Zeini
- AdventHealth Research Institute
- Orthopedic Institute, 301 E Princeton St, Orlando, FL, 32804, USA
| | - Benjamin Service
- Orlando Health Jewett Orthopedic Institute, 7243 Della Drive, Floor 2, Suite I, Orlando, FL, 32819, USA
| | - D Harrison Youmans
- Rothman Orthopaedic Institute Florida, 410 Lionel Way Suite 201, Davenport, FL, 33837, USA
| | - Daryl C Osbahr
- Rothman Orthopaedic Institute Florida, 410 Lionel Way Suite 201, Davenport, FL, 33837, USA
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Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes. BMC Anesthesiol 2021; 21:226. [PMID: 34525959 PMCID: PMC8442468 DOI: 10.1186/s12871-021-01442-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/28/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. METHODS The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). RESULTS A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. CONCLUSIONS The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.
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Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here's Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful. Arthroscopy 2020; 36:1584-1586. [PMID: 32503772 DOI: 10.1016/j.arthro.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023]
Abstract
Hip arthroscopy is known to be a relatively safe procedure with a limited and unique set complications and low hospital readmission rates. Many patients, however, may seek emergency department evaluation after surgery for postoperative pain or complaints unrelated to the most commonly cited complications, such as traction neuropraxia. It is important to recognize and understand the reasons why patients seek medical care after surgery because many of these encounters may be preventable with optimization of perioperative multimodal pain control regimens and proper patient education regarding their expected postoperative course. Patients with barriers to health care access, such as Medicare and Medicaid patients, may be at higher risk for emergency department evaluation of their problems after surgery and clinicians should consider providing additional counseling to these patients regarding when and how to seek medical evaluation after surgery.
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Malviya A. Editorial Commentary: Readmission Rate After Hip Arthroscopy: Is There a Cause for Concern? Arthroscopy 2019; 35:3278-3279. [PMID: 31785757 DOI: 10.1016/j.arthro.2019.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/13/2019] [Indexed: 02/02/2023]
Abstract
Readmission after hip arthroscopic surgery is an undesired and unusual event. The causes may range from wound-related issues, deep infection, increasing pain, complications of surgery, to medical events. It adds to the economic burden of the procedure and causes unnecessary anguish to the patients and indeed clinicians. It is also one of the less-studied areas of hip arthroscopic surgery because of its rarity. There would be benefit in being able to identify the risk factors of readmission such that pre-emptive measures can be put in place to prevent or indeed counsel the patients before the surgery. In certain cases, readmission may remain an unpreventable event. In our experience, the readmission rate after hip arthroscopy is 0.5%, whereas patients with elevated body mass index are at greater risk.
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