Erratum to 'Conversion From Knee Arthrodesis Back to Arthroplasty: A Particular Challenge in Combination With Fungal Periprosthetic Joint Infection' [Arthroplasty Today 6 (2020) 1038-1044].

[This corrects the article DOI: 10.1016/j.artd.2020.10.007.].

Risk Factors Associated with 90-Day Readmissions Following Occipitocervical Fusion-A Nationwide Readmissions Database Study.

BACKGROUND: Occipitocervical fusion (OCF) procedures are increasing due to an aging population and the prevalence of trauma, rheumatoid arthritis, and tumors. Reoperation rates and readmission risk factors for cervical fusions have been established, but in relation to OCF they have not been explored. This study investigates the patterns of readmissions and complications following OCF using a national database. METHODS: The 2016 U.S. Nationwide Readmissions Database was used for sample collection. Adults (>18 years) who underwent OCF were identified using the 2016 ICD-10 coding system, and we examined the readmission rates (30-day and 90-day) and reoperation rates. RESULTS: Between January and September 2016, a total of 477 patients underwent OCF; the 30-day and 90-day readmission rates were 10.4% and 22.4%, respectively. The 90-day reoperation rate related to the index surgery was 5.7%. Mean age (68.58 years) was significantly greater in the readmitted group versus nonreadmitted group (61.76 years) (P < 0.001). The readmitted group had a significantly higher Charlson Comorbidity Index and Elixhauser Comorbidity Index (5.00 and 2.41, respectively) than the nonreadmitted group (3.25 and 1.15, respectively; P < 0.001). Nonelective OCF showed a higher readmission rate (29.18%) versus elective OCF (12.23%) (P < 0.001). Medicare and Medicaid patients showed the highest rates of readmission (27.27% and 20.41%, respectively). Readmitted patients had higher total health care costs. CONCLUSIONS: Nonelective OCF was found to have a readmission rate of almost 2½× that of elective OCF. Understanding risk factors associated with OCF will help with operative planning and patient optimization.

Osteology of the ilium revised: illuminating the clinical relevance.

BACKGROUND: Several studies on anterior and posterior pelvic ring fixation have identified a fragile monocortical area located at the iliac wing. However, there are no current studies regarding this structure's dimensions and relation to known anatomic structures. METHODS: Eleven human ilia were dissected from 6 specimens. After debulking soft tissue, photoluminescence was used to indicate the fragile area. The size and thickness of the iliac wing were determined and mapped in relation to the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). RESULTS: This photoluminescent unicortical area measured 15.57 cm2 with a mean minimal thickness of 1.37 mm at its thinnest part. Its average diameter was 41.15 mm horizontally and 37.45 mm vertically. In all cases, it was located at the middle third of the ilium with a mean distance of 64.58 mm to the AIIS and 62.73 mm to the PSIS. Trajectory angulation above 4.5° from the PSIS lead to violation of this area. CONCLUSION: This study provides useful anatomical information regarding a thin unicortical area at the iliac wing that is relevant to anterior and posterior pelvic ring fixation and the potential complications that can arise from iatrogenic perforation of this area.

The impact of the 30 most cited articles on hip arthroscopy: what is the subject matter?

The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on recent surgical treatment. Due to advancements in hip arthroscopy, there is a widening spectrum of diagnostic and treatment indications. The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on contemporary surgical treatment. The Thomson Reuters Web of Science was used to identify the 30 most cited studies on hip arthroscopy between 1900 and 2018. These 30 articles generated 6152 citations with an average of 205.07 citations per item. Number of citations ranged from 146 to 461. Twenty-five out of the 30 papers were clinical cohort studies with a level of evidence between III and IV, encompassing 4348 patients. Four studies were reviewed (one including a technical note) and one a case report. We were able to identify the 30 most cited articles in the field of hip arthroscopy. Most articles were reported in high-impact journals, but reported small sample sizes in a retrospective setting. Prospective multi-arm cohort trials or randomized clinical trials represent opportunities for future studies.

Emerging Insight in the Use of an Active Post Discharge Surveillance Program in Spine Surgery: A Retrospective Pilot Study.

BACKGROUND: With smartphones being present in everyday life, we have witnessed an increasing use of applications designed for mobile communication devices that are aimed at facilitating patient engagement in different medical arenas. Such applications are meant to improve communications with patients and ultimately improve patient care. The aim of this study was to report on our early experiences using Active Post Discharge Surveillance (APDS) relative to invasiveness of the spine surgery and patient age and gender. METHODS: A retrospective chart review was performed including all patients who volunteered to use application-based APDS between September 1, 2017, and September 30, 2018. The primary outcome was the number of APDS uses. Secondary outcomes were inquiries that led to a change of treatment or induced a readmission and patient satisfaction. Regression analysis was performed regarding the influence of invasiveness, age, and gender on the incidence of APDS use. RESULTS: The average number of individual APDS communications was 3.6 with no difference between degrees of severity of invasive surgery, age, or gender. APDS inquiries induced unexpected readmissions in 4 patients (66.6% of all readmissions) and postoperative treatment regimen changes in 4 other patients. Thirty-three patients (86.8%) reported being satisfied with APDS usage. CONCLUSIONS: This is the first study to investigate use of interactive APDS in patients undergoing elective spine surgery. Our data suggest that patient age, gender, or invasiveness of surgery is not associated with the usage of APDS.

Tulip-Screw Head Disjunction from Posterior C2 Fracture Fixation Instrumentation.

This report presents an unusual case of instrumentation failure after posterior fixation of a C2 fracture and reviews currently available treatment alternatives. The patient, a 53-year-old female, initially presented to the emergency department at an outside facility with acute alcohol intoxication and acute neck pain following a fall from a ladder. CT demonstrated bilateral C2 pars fractures and unstable posteroinferior displacement of the posterior elements. She underwent an emergent C2 open-reduction internal fixation (ORIF) at the outside facility with 3.5 mm polyaxial synapse pedicle screws (DePuy Synthes, Switzerland). There were no known complications and the patient was discharged. Two years after the index operation, cervical CT scan at a different facility revealed that although the fracture was fully healed, bilateral tulip caps had detached from the pedicle screw heads at C2. All implants were removed without postoperative complications. Industry review of alternate lag screws approved for the cervical spine demonstrated that there is not currently an ideal implant for fixation of C2 fractures without fusion. Cannulated trauma screws, which are low profile and would have avoided the instrumentation failure seen here, are not currently FDA approved for the cervical spine.

Conversion From Knee Arthrodesis Back to Arthroplasty: A Particular Challenge in Combination With Fungal Periprosthetic Joint Infection.

A 58-year-old female treated at an outside facility with knee arthrodesis due to persistent periprosthetic joint infection fulfilled all prerequisites for a conversion back to arthroplasty, as part of a 2-stage revision. Owing to the detection of Candida parapsilosis, the treatment concept was converted to a three-stage procedure. A scheduled spacer exchange with additional amphotericin B-loaded polymethylmethacrylate was conducted as an intermediate revision before reimplantation. Conversion in the setting of fungal periprosthetic joint infection presents a challenge, and successful treatment hinges on the use of proper antifungal and antimicrobial protocols, advanced surgical techniques, and a multidisciplinary team approach. At the 3-year follow-up, successful infection eradication as measured by the Delphi-based consensus definition was achieved with a range of motion of 0°-100°.