Longer Operative Time and the Use of Anticoagulants Are Associated With Increased Blood Loss in Elderly Patients Undergoing Arthroscopic Rotator Cuff Repair.

Purpose: To study the effects of rotator cuff tear size, operation time, and the use of anticoagulant on blood loss in elderly patients undergoing arthroscopic rotator cuff surgery. Methods: Patients aged older than 65 years who underwent arthroscopic rotator cuff repair with subacromial decompression at our hospital from January 2015 to December 2021 were identified. We measured hemoglobin levels preoperatively, postoperatively, and 7 days after surgery. First, subjects were divided according to the operation time (group I, <90 minutes; group II, <120 minutes; group III <150 minutes; and group IV, >150 minutes). Second, we classified the subjects by the size of the rotator cuff tear (group A, <3 cm; group B, <5 cm; and group C, >5 cm). Lastly, we categorized the subjects into 2 groups according to the use of anticoagulant medication. Results: A total of 566 patients were included. The mean hemoglobin (Hgb) levels were 13.8 ± 1.4 g/dL preoperatively, 13.2 ± 1.4 g/dL postoperatively, and 12.8 ± 1.3 g/dL 7 days after surgery, and the differences among them were statistically significant (P < .001). The Hgb level changes 7 days after surgery showed a significant decrease in the group with a longer operation time, and the Hgb loss increased from group 1 to group 4 (P < .001). They did not show any difference in the Hgb levels among the groups according to the size of a cuff tear preoperatively, postoperatively, and 7 days after surgery. The subjects with anticoagulant use showed more decrease in Hgb levels between immediately after the surgery and 7 days after the surgery (P = .031). Still, both groups did not show a statistical difference in the Hgb level 7 days after surgery (P = .115). Conclusions: In this study, blood loss after arthroscopic rotator cuff repair in elderly patients was greater than expected. Bleeding increased in elderly patients who had longer surgical times or were taking anticoagulant medications after surgery. Tear size was not associated with a decrease in Hgb levels. Level of Evidence: Level III, retrospective comparative study.

Clinical utility of skin perfusion pressure measurement in diabetic foot wounds: An observational study.

The degree of blood vessel stenosis significantly influences diabetic foot treatment. This study aimed to investigate the association between computed tomography angiography (CTA) stenosis and skin perfusion pressure (SPP), which are noninvasive vascular assessments used to evaluate diabetic foot wounds. Forty patients who reported diabetic foot wounds between November 2016 and December 2017 were included in the study. SPPand CTA were performed to evaluate the blood flow, and the rate of decrease in wound size was measured for the wounds corresponding to Meggitt-Wagner grade 1 at the first evaluation and 4-week intervals. The P value of the association between the degree of CTA stenosis and the SPP value was 0.915, and the P value of the association between CTA stenosis and decreasing rate of wound size was .235. There was no statistically significant association between SPP and the decreasing rate of wound size according to the degree of CTA stenosis. The association between SPP value and the decreasing rate of wound size was statistically significant (P < .05). The decreasing rate in diabetic foot wound size was significantly associated with SPP but not with CTA stenosis.

Does spinopelvic motion change after total hip arthroplasty?

PURPOSE: Spinopelvic motion plays an important role in functional acetabular cup position after total hip arthroplasty (THA). Sacral slope (SS) has been a useful surrogate for spinopelvic motion. The present study aimed to investigate statistical characteristics of spinopelvic motion before and after THA using changes in SS in supine, standing, and sitting positions. METHODS: A total of 76 patients (88 hips) were assessed. To classify spinopelvic mobility, defined as a change in SS from standing to sitting position (ΔSSstand/sit), 10° ≤ ΔSSstand/sit ≤ 30°, ΔSSstand/sit < 10°, and ΔSSstand/sit > 30° were considered normal, stiff, and hypermobile, respectively. RESULTS: Over ± 7° changes in SS between before and one year after THA were observed in 39 (44.3%) hips in the sitting position, 19 (21.6%) hips in the supine position, seven (7.9%) in the standing position. Percentages of hips with stiff spinopelvic mobility (11.4% vs. 22.7%) and hypermobile spinopelvic mobility (23.9% vs. 12.5%) between before THA and one year after THA were significantly different (p = 0.034 and p = 0.016, McNemar's test). At one year after THA, 40.0% (4/10) of hips with stiff spinopelvic mobility and 57.1% (12/21) of hips with hypermobile spinopelvic mobility shifted to normal spinopelvic mobility. CONCLUSIONS: Change in SS between before THA and one year after THA had a high inter-subject variability especially in the sitting position. In addition, there was a distinct shift to normal spinopelvic mobility postoperatively in hips with stiff and hypermobile spinopelvic mobility pre-operatively.

Periprosthetic occult acetabular fracture: an unknown side effect of press-fit techniques in primary cementless total hip arthroplasty.

BACKGROUND: This study sought to investigate the prevalence and risk factors of periprosthetic occult acetabular fracture occurring during cementless acetabular cup insertion in patients undergoing primary total hip arthroplasty (THA) and to assess the clinical consequences of these fractures. METHODS: A total of 232 hips (n = 205 patients) were included in this study. A periprosthetic occult acetabular fracture was defined as that which was unrecognised intraoperatively and was undetectable on post-operative radiographs yet was successfully diagnosed on post-operative computed tomography (CT) images. Clinical (age, sex, body mass index, and preoperative diagnosis) and surgical (additional screw fixation, cup rim size, and cup type) variables were analysed to identify risk factors for periprosthetic occult acetabular fracture. RESULTS: Sixteen (6.9%) periprosthetic occult intraoperative acetabular fractures were identified. In addition, one (0.4%) periprosthetic acetabular fracture was found during operation. The superolateral wall (9/16 hips; 56.3%) was the most frequent location. In addition, one (0.4%) periprosthetic acetabular fracture was found during operation. Male sex was the only factor associated with an increased risk for periprosthetic occult intraoperative acetabular fracture (odds ratio for male versus female sex: 4.28; p = 0.04). There was no significant association between cup type and the occurrence of periprosthetic occult acetabular fracture. All 16 hips with periprosthetic occult intraoperative acetabular fracture were healed at the final follow-up visit without the requirement for any additional surgical interventions. CONCLUSION: The results of the current study suggest that periprosthetic occult acetabular fractures are common during press-fit acetabular cup insertion in primary THA. Surgeons should have a high index of suspicion and early CT imaging referral in male patients who present with unexplained early post-operative groin pain in primary THA using cementless acetabular cups.