Early Implant Failure of a 2-Level M6-Cervical Total Disc Replacement: A Case Report.

CASE: We report a case of implant failure after primary 2-level M6-cervical disc replacement (M6-C; Spinal Kinetics) at C4-5 and C5-6. At revision surgery, a full-thickness tear was identified in the sheath of the C5-6 implant. Histology from periprosthetic tissue demonstrated polyethylene particles without acute inflammation. Tissue cultures were positive for Propionibacterium acnes, but ultrasonicate cultures were negative for both prostheses. An independent laboratory test confirmed mechanical failure of the C5-6 prosthesis. CONCLUSION: This is the first report of mechanical failure associated with wear-debris osteolysis after M6-C disc arthroplasty. Therefore, continued surveillance after CTDR is necessary.

Facial Numbness and Paresthesias Resolved with Anterior Cervical Decompression and Fusion: A Report of 3 Cases.

CASE: We report 3 patients with classic trigeminal neuropathy (TN) findings, which were due to compressive cervical radiculopathy, and provide a brief anatomic explanation for this association. In each case, left-sided disk herniation between the C5 and C7 levels caused TN and classic (dermatome appropriate) cervical radicular findings, all of which resolved with anterior cervical decompression and fusion (ACDF). CONCLUSIONS: To our knowledge, this is the first report of TN caused by radicular compression in the caudal subaxial (C5-C7) cervical spine, which resolved after ACDF.

Incidence of Patella Baja Before and After Primary Total Knee Arthroplasty Based on Body Mass Index.

In the setting of total knee arthroplasty, patella baja has been associated with decreased range of motion and increased risk of certain extensor mechanism complications. The goal of this study was to determine whether obese patients had an increased prevalence of patella baja before and/or after primary total knee arthroplasty. A multicenter retrospective review of 5089 unilateral total knee arthroplasties performed between 1998 and 2012 for osteoarthritis was conducted. Only total knee arthroplasties with cemented modular, metal-backed constructs and patellar resurfacing were included. An a priori power analysis determined that 500 patients (stratified into 5 World Health Organization body mass index groups, matched by age and sex) were needed to detect a significant Insall-Salvati ratio difference of 0.07. Patella baja was defined as an Insall-Salvati ratio of less than 0.8. Preoperative and postoperative Insall-Salvati ratios were compared between groups and analyzed using linear regression and analysis of variance. Preoperatively, there was a higher prevalence of patella baja in the higher body mass index groups (>25 kg/m2) compared with normal weight patients (10% vs 6%; P=.02). Postoperatively, there was no difference in the prevalence of patella baja between the 2 groups (5% vs 5%; P=.91). On comparison of postoperative Insall-Salvati ratio with preoperative Insall-Salvati ratio, the higher body mass index groups had a greater change in Insall-Salvati ratio (Δ 0.10 vs Δ 0.07; P=.01). This is the first study to report an increased prevalence of patella baja in obese patients and to show that the prevalence normalizes to that of a control group after total knee arthroplasty. Obese patients undergoing primary total knee arthroplasty had a higher rate of preoperative patella baja. [Orthopedics. 2019; 42(2):90-94.].

Surgical site infection in orthopedic trauma: A case-control study evaluating risk factors and cost.

BACKGROUND: With the shift of our healthcare system toward a value-based system of reimbursement, complications such as surgical site infections (SSI) may not be reimbursed. The purpose of our study was to investigate the costs and risk factors of SSI for orthopedic trauma patients. METHODS: Through retrospective analysis, 1819 patients with isolated fractures were identified. Of those, 78 patients who developed SSIs were compared to 78 uninfected control patients. Patients were matched by fracture location, type of fracture, duration of surgery, and as close as possible to age, year of surgery, and type of procedure. Costs for treatment during primary hospitalization and initial readmission were determined and potential risk factors were collected from patient charts. A Wilcoxon test was used to compare the overall costs of treatment for case and control patients. Costs were further broken down into professional fees and technical charges for analysis. Risk factors for SSIs were analyzed through a chi-squared analysis. RESULTS: Median cost for treatment for patients with SSIs was $108,782 compared to $57,418 for uninfected patients (p < 0.001). Professional fees and technical charges were found to be significantly higher for infected patients. No significant risk factors for SSIs were determined. CONCLUSIONS: Our findings indicate the potential for financial losses in our new healthcare system due to uncompensated care. SSIs nearly double the cost of treatment for orthopedic trauma patients. There is no single driver of these costs. Reducing postoperative stay may be one method for reducing the cost of treating SSIs, whereas quality management programs may decrease risk of infection.