Using Nasal Self-Esteem to Predict Revision in Cosmetic Rhinoplasty

2020 ◽  
Author(s):  
Tyler S Okland ◽  
Priyesh Patel ◽  
George S Liu ◽  
Sam P Most
Keyword(s):  
Revision Surgery ◽  
Revision Rate ◽  
Retrospective Chart Review ◽  
Self Esteem ◽  
Level Of Evidence ◽  
Survey Question ◽  
Outcomes Measures ◽  
Cosmetic Rhinoplasty ◽  
The Mean ◽  
Single Question

Abstract Background It would be useful if existing tools or outcomes measures could predict which patients are at greater risk of revision surgery following rhinoplasty. Objectives The authors sought to determine if a single question assessing nasal self-esteem could be utilized to predict which patients are at greatest risk of revision surgery following rhinoplasty. Methods The authors conducted a retrospective chart review of 148 patients who underwent cosmetic rhinoplasty. Results of pre- and postoperative Standardized Cosmesis and Health Nasal Outcomes Survey questionnaires and rates of revision or patient-initiated revision discussions (RD) were collected. Patients were stratified based on answers to Standardized Cosmesis and Health Nasal Outcomes Survey question 5 (SQ5), “Decreased mood and self-esteem due to my nose.” Results Of the 148 patients included in the analysis, 72.9% were women, and the mean age was 30.9 (15-59, standard deviation = 10.3) years. Those patients who selected 4 or 5 on SQ5 had an overall revision rate of 16.7% and 18.8%, respectively, and a RD rate of 27.8% and 31.25%, respectively. Those patients who selected 0 through 3 on SQ5 had an overall revision rate of 0% and an overall RD rate of 10.4%. Only SQ5 was predictive of revision and RD on logistic regression analysis (P = 0.0484 and P = 0.0257) after Bonferroni correction. Conclusions SQ5 appears to offer a useful adjunct to guide surgical management of the cosmetic rhinoplasty patient. Those patients who reported worse nasal self-esteem and associated mood preoperatively were more likely to request and undergo revision. Level of Evidence: 4  

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

scholarly journals Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

2021 ◽  
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Carlos A. Higuera ◽  
Juan C. Suarez ◽  
Preetesh D. Patel ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Adverse Events ◽  
Hip Arthroplasty ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Exact Test ◽  
Total Hip ◽  
Discharge Disposition ◽  
The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

scholarly journals Secondary Composite Breast Augmentation: Concept and Outcomes, Introduction to a Layered Approach

2020 ◽  
Vol 40 (9) ◽  
pp. 981-986 ◽  
Author(s):  
Eric Auclair ◽  
Alexandre Marchac ◽  
Nathalie Kerfant
Keyword(s):  
Soft Tissue ◽  
Revision Surgery ◽  
Breast Augmentation ◽  
Revisional Surgery ◽  
Treatment Plan ◽  
Fat Grafting ◽  
Level Of Evidence ◽  
Soft Tissue Envelope ◽  
The Mean ◽  
Over Time

Abstract Background Secondary procedures following breast augmentation are often more difficult than primary cases because the soft-tissue envelope changes over time. Objectives This study was conducted to confirm the utility of a composite technique in breast revisional surgery. Methods This was a 9-year retrospective chart and photographic data study of one surgeon’s experience with the combined use of fat and implants in revisional cases. The 148 patients had a follow-up at least 1 year after surgery. Our approach consists of a detailed analysis of the different layers covering the implant and yields a treatment plan addressing all issues involving the secondary breast. Results On average, revisional surgery was performed 8.66 years after the first augmentation. The mean age of the patients at revision surgery was 42 years (range, 22.2-70.7 years). The mean fat harvest was 600 mL (range, 100-3000 mL) and the mean volume of fat reinjected was 153 mL (range, 60-400 mL). The mean volume before and after revision was the same (288 mL vs 289 mL). At the original surgery, the breast implants were located in a subpectoral pocket in 78.7% of the patients and, at the revision surgery, in a subglandular pocket in 74.8% of the patients. Within the first 2 years, 13 patients (8.7%) underwent reoperation for additional fat grafting. Among 45 preoperative breast capsular contractures, there were 8 recurrences in the first 3 years resulting in 4 reoperations. Conclusions Secondary breast augmentation cannot rely solely on implant exchange. Because the soft-tissue envelope also ages over time, fat grafting is mandatory in the vast majority of secondary cases. A rigorous preoperative analysis enables breast defects to be treated appropriately. Level of Evidence: 4

Sports and Recreation Activity of Varus and Valgus Ankle Osteoarthritis before and after Realignment Surgery

2008 ◽  
Vol 29 (10) ◽  
pp. 985-993 ◽  
Author(s):  
Geert Pagenstert ◽  
André Leumann ◽  
Beat Hintermann ◽  
Victor Valderrabano
Keyword(s):  
Revision Surgery ◽  
Revision Rate ◽  
Distal Tibia ◽  
Case Series ◽  
Joint Surface ◽  
Ankle Pain ◽  
Ankle Osteoarthritis ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Sports Activity

Background: Realignment-surgery to unload ankle osteoarthritis (OA) has been proposed as treatment alternative for varus and valgus ankle OA. Sports activity after this procedure has not been analyzed. Realignment-surgery increases sports activity. Sports activity correlates with ankle pain, function, and alignment, but does not influence revision rate. Materials and Methods: Prospective case series of 35 consecutive patients with post-traumatic varus or valgus ankle OA limited to half tibiotalar joint surface were treated by OA unloading realignment-surgery. Distal tibia osteotomy was used in all cases; additional osteotomies, tendon, ligament procedures in 92% of cases. Main Outcome Measurements: Pain (visual-analogue-scale; VAS), ankle range-of-motion (ROM); function (American-Orthopaedic-Foot-and-Ankle-Society (AOFAS) ankle-score; Swiss-symptom-related-Ankle-Activity-Scale (SAAS); Sports-Frequency-Score (SFS), OA and tibiotalar-alignment-grade (Takakura-Score), and revision surgery. Mean followup was 5 years. Results: Mean values from preoperative to followup: VAS decreased ( p = 0.0001) 4 points; ankle ROM increased ( p = 0.001) 5 degrees; AOFAS-Score increased ( p = 0.0001) 46 points; SAAS increased ( p = 0.0001) 42 points; SFS increased ( p = 0.02) 0.5 grades; Takakura-score decreased ( p = 0.0001) 1.0 grades. Revision surgery was performed in 10 cases (29%). Three of these were revised to ankle arthroplasty. At follow-up, SAAS correlated with VAS, AOFAS score, Takakura score, and not with ROM or SFS. SFS did not correlate with other variables. Patients needing revision surgery had a higher ( p = 0.003) SFS than patients who needed no revision. Conclusion: Realignment-surgery increased sports activity of ankle OA patients. Improved ankle pain and function correlated with ability to perform activity without symptoms; however, sports frequency had no correlation to patients' symptoms but showed higher revision rate. Level of Evidence: II, Prospective Comparative Study

Relationship of Postoperative Achilles Tendon Elongation With Plantarflexion Strength Following Surgical Repair

2019 ◽  
Vol 41 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Önder Murat Hürmeydan ◽  
Mehmet Demirel ◽  
Natig Valiyev ◽  
Turker Sahinkaya ◽  
Önder İsmet Kılıçoğlu
Keyword(s):  
Achilles Tendon ◽  
Chart Review ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Isokinetic Dynamometer ◽  
Level Of Evidence ◽  
Tendon Elongation ◽  
The Mean ◽  
Relationship Of

Background: Little data exist regarding the adverse effects of Achilles tendon (AT) elongation after rupture repair on plantarflexion strength. This study aimed to investigate the effect of AT elongation measured using AT resting angle (ATRA) on the plantarflexion strength in patients with surgically treated acute AT rupture. Methods: A retrospective chart review was performed on 40 patients (15 female and 25 female) who underwent open operative repair due to an acute AT rupture. At the final follow-up, AT elongation was assessed using ATRA. Plantarflexion strength (peak torques and angle-specific torques) was measured using an isokinetic dynamometer. All variables were obtained from the operated and unoperated contralateral ankles of the patients. Results: The mean ATRA was greater in the operated ankles (mean, 57 degrees; range, 39-71 degrees) compared with the unoperated ones (mean, 52 degrees; range, 36-66 degrees; P = .009). Except the plantarflexion torque at 20 degrees of plantarflexion ( P = .246), all the other angle-specific torques were lower in the operated ankles ( P < .05). Peak flexion torque at 30 degrees/s was lower in the operated ankle ( P = .002). A negative correlation was found between operated/unoperated (O/N) ATRA and O/N plantarflexion torque ratios at 0 degrees ( r = −0.404; P = .01), 10 degrees ( r = −0.399; P= .011), and 20 degrees ( r = −0.387; P = .014). Conclusion: Postoperative AT elongation measured using ATRA may have a deleterious effect on the plantarflexion strength in patients with surgically treated acute AT rupture. Level of Evidence: Level IV, case series.

scholarly journals The Value of Cement Augmentation in Patients With Diminished Bone Quality Undergoing Thoracolumbar Fusion Surgery: A Review

2021 ◽  
Vol 11 (1_suppl) ◽  
pp. 37S-44S
Author(s):  
Joshua M. Kolz ◽  
Brett A. Freedman ◽  
Ahmad N. Nassr
Keyword(s):  
Bone Quality ◽  
Revision Surgery ◽  
Revision Rate ◽  
Pedicle Screws ◽  
Cost Effective ◽  
Cement Augmentation ◽  
Fusion Surgery ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Study Design: Systematic review. Objectives: Osteoporosis predisposes patients undergoing thoracolumbar (TL) fusion to complications and revision surgery. Cement augmentation (CA) improves fixation of pedicle screws to reduce these complications. The goal of this study was to determine the value and cost-effectiveness of CA in TL fusion surgery. Methods: A systematic literature review was performed using an electronic database search to identify articles discussing the cost or value of CA. As limited information was available, the review was expanded to determine the mean cost of primary TL fusion, revision TL fusion, and the prevalence of revision TL fusion to determine the decrease of revision surgery necessary to make CA cost-effective. Results: Two studies were identified discussing the cost and value of CA. The mean cost of CA for two vertebral levels was $10 508, while primary TL fusion was $87 346 and revision TL fusion was $76 825. Using a mean revision rate of 15.4%, the use of CA for TL fusion would need to decrease revision rates by 13.7% to be cost-effective. Comparison studies showed a decreased revision rate of 11.3% with CA, which approaches this value. Conclusion: CA for TL fusion surgery improves biomechanical fixation of pedicle screws and decreases complications and revision surgery in patients with diminished bone quality. The costs of CA are substantial and reported decreases in revision rates approach but do not reach the calculated value to be a cost-effective technique. Future studies will need to focus on the optimal CA technique to decrease complications, revisions, and costs.

Outcome of arthroscopic reduction association of the scapholunate joint

2015 ◽  
Vol 41 (1) ◽  
pp. 48-55 ◽  
Author(s):  
S. M. Koehler ◽  
S. M. Guerra ◽  
J. M. Kim ◽  
S. Sakamoto ◽  
A. J. Lovy ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Visual Analogue Score ◽  
Dash Score ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Scapholunate Instability ◽  
Arthroscopic Reduction ◽  
Loss Of Reduction ◽  
The Mean

This study evaluates the arthroscopic reduction association scapholunate technique and outcomes. A total of 18 patients with chronic scapholunate instability with mean follow-up of 36 months were reviewed. Postoperatively, the mean visual analogue score was 2.5 and the mean DASH score was 8. The grip strength was 27 kg on the operative side compared with 32 kg on the uninjured side. The mean wrist flexion was 46° and extension was 56°. Seven patients had complications. Six patients had scapholunate joint widening, one had windshield-wipering of the screws with loss of reduction, and two demonstrated progression of scapholunate advanced collapse deformity. Four patients underwent revision surgeries: two revision arthroscopic reduction association scapholunates and two proximal row carpectomies. A preoperative scapholunate gap of greater than 5 mm and the presence of scapholunate advanced collapse Grade I were both predictive of a complication or revision surgery. Patients with a scapholunate gap of greater than 5 mm or scapholunate advanced collapse had statistically higher complications rates. Level of Evidence IV.

scholarly journals Does the IOFix implant Improve Union Rates?

2020 ◽  
Author(s):  
david segal ◽  
Nissim Ohana ◽  
Meir Nyska ◽  
Ezequiel Palmanovich
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Fusion Rate ◽  
Hallux Rigidus ◽  
Hardware Removal ◽  
Functional Score ◽  
Level Of Evidence ◽  
Operation Rate ◽  
The Mean

Abstract BACKGROUND First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODS We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36±9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2±12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5±10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.CONCLUSIONS This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.LEVEL OF EVIDENCE: 4

Results of proximal interphalangeal arthroplasty: border digits versus middle digits

2020 ◽  
Vol 45 (7) ◽  
pp. 709-714
Author(s):  
Eric R. Wagner ◽  
Laurel A. Barras ◽  
Michael W. Fort ◽  
William Robinson ◽  
Marco Rizzo
Keyword(s):  
Revision Surgery ◽  
Revision Rate ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Implant Survival ◽  
Level Of Evidence ◽  
Joint Dislocations ◽  
Significant Difference ◽  
Joint Arthroplasties ◽  
Reoperation Rates

This investigation assessed 106 consecutive primary proximal interphalangeal joint arthroplasties performed on border digits: 73 index or 33 little fingers. This was compared with 193 arthroplasties performed in non-border digits: 121 middle or 72 ring fingers. There were 20 proximal interphalangeal joint arthroplasties in the border digits that required revision surgery for pain and stiffness (10 digits), dislocation (six digits), implant fracture (one digit), and infection (three digits). Risk of revision surgery was not associated with border digit. The 5-year implant survival rate for the border digits was 81%. There was no significant difference in implant revision rate or joint dislocations between border and non-border digits. We conclude that proximal interphalangeal joint arthroplasties performed in border digits had similar pain relief, survivorship, complications, and reoperation rates compared with those performed in non-border digits. Level of evidence: IV

scholarly journals The effect of obesity on revision rate in unicompartmental knee arthroplasty: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Omar Musbahi ◽  
Thomas W. Hamilton ◽  
Adam J. Crellin ◽  
Stephen J. Mellon ◽  
Benjamin Kendrick ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Revision Rate ◽  
Meta Analysis ◽  
Obese Patients ◽  
Level Of Evidence ◽  
Unicompartmental Knee ◽  
Significant Difference ◽  
The Mean

Abstract The number of patients with knee osteoarthritis, the proportion that is obese and the number undergoing unicompartmental knee arthroplasty (UKA) are all increasing. The primary aim of this systematic review was to determine the effects of obesity on outcomes in UKA. A systematic review was performed using PRISMA guidelines and the primary outcome was revision rate per 100 observed component years, with a BMI of ≥ 30 used to define obesity. The MINORS criteria and OCEBM criteria were used to assess risk of bias and level of evidence, respectively. 9 studies were included in the analysis. In total there were 4621 knees that underwent UKA. The mean age in included studies was reported to be 63 years (mean range 59.5–72 years old)) and range of follow up was 2–18 years. Four studies were OCEBM level 2b and the average MINORS score was 13. The mean revision rate in obese patients (BMI > 30) was 0.33% pa (95% CI − 3.16 to 2.5) higher than in non-obese patients, however this was not statistically significant (p = 0.82). This meta-analysis concludes that there is no significant difference in outcomes between obese and non-obese patients undergoing UKA. There is currently no evidence that obesity should be considered a definite contraindication to UKA. Further studies are needed to increase the numbers in meta-analysis to explore activity levels, surgeon’s operative data, implant design and perioperative complications and revision in more depth. Level of evidence Level III.

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