Impact of femoral varus on complications and outcome associated with corrective surgery for medial patellar luxation

2017 ◽  
Vol 30 (04) ◽  
pp. 288-298 ◽  
Author(s):  
Robert Adams ◽  
Shane Andrews ◽  
Charlie Tewson ◽  
Mieghan Bruce ◽  
Karen Perry
Keyword(s):  
Postoperative Complications ◽  
Selection Criteria ◽  
Surgical Techniques ◽  
Major Complication ◽  
Femoral Osteotomy ◽  
Corrective Surgery ◽  
Distal Femoral Osteotomy ◽  
Radiographic Measurements ◽  
Potential Risk Factors ◽  
Varus Angle

SummaryObjectives: To evaluate the association of femoral varus with postoperative complications and outcome following standard corrective surgery for medial patellar luxation (MPL) without distal femoral osteotomy (DFO) in dogs.Methods: In a retrospective study spanning a 12 year period, 87 stifles with MPL that were treated by standard surgical techniques were included. Inclination angle (ICA), femoral varus angle (FVA), anatomical lateral distal femoral angle (aLDFA), and mechanical lateral distal femoral angle (mLDFA) were measured. Postoperative complications were noted and outcome evaluated. Associations between potential risk factors and both complication rate and outcome were assessed.Results: Postoperative complications occurred in 19 stifles, five of which were major. There was no evidence of an association between FVA (p = 0.41) or aLDFA (p = 0.38) and any complication. There was also no evidence of an association between FVA (p = 0.31) or aLDFA (p = 0.38) and any major complication. Dogs with a larger aLDFA had increased odds of a poorer outcome (p = 0.01) as did dogs that suffered a major complication (p = 0.0001).Clinical significance: Based on radiographic measurements, there is no evidence of an association between FVA and the incidence of postoperative complications following standard MPL correction. Traditional surgical techniques appear to be appropriate for most cases of MPL and further work is required to better define selection criteria for including DFO in the treatment of these cases.

scholarly journals Frailty as a risk factor for postoperative complications in adult patients with degenerative scoliosis administered posterior single approach, long-segment corrective surgery: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bin Li ◽  
Xianglong Meng ◽  
Xinuo Zhang ◽  
Yong Hai
Keyword(s):  
Risk Factor ◽  
Postoperative Complications ◽  
Posterior Approach ◽  
Frailty Index ◽  
Cardiac Complications ◽  
Corrective Surgery ◽  
Degenerative Scoliosis ◽  
Acute Renal Dysfunction ◽  
Radiographic Measurements ◽  
Single Approach

Abstract Background With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Frailty, instead of chronological age, is used for assessing the patient’s overall physical condition. In ADS patients undergoing a posterior approach, long-segment corrective surgery, the association of frailty with the postsurgical outcomes remains undefined. Methods ADS patients who underwent a posterior approach, long-segment fusion at the Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University (CMU), Beijing, China, in 2014–2017 were divided into the frailty and non-frailty groups according to the modified frailty index. Major postoperative complications were recorded, including cardiac complications, pneumonia, acute renal dysfunction, delirium, stroke, neurological deficit, deep wound infection, gastrointestinal adverse events, and deep vein thrombosis. Radiographic measurements and health-related quality of life (HRQOL) parameters were recorded preoperatively and at 2 postoperative years. Results A total of 161 patients were included: 47 (29.2%) and 114 (70.8%) in the frailty and non-frailty groups, respectively. Major postoperative complications were more frequent in the frailty group than the non-frailty group (29.8% vs. 10.5%, P = 0.002). Multivariable logistic regression analysis showed that frailty was independently associated with major complications (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.12–6.89, P = 0.028). Radiographic and HRQOL parameters were improved at 2 years but with no significant between-group differences. Conclusions Frailty is a risk factor for postoperative complications in ADS after posterior single approach, long-segment corrective surgery. Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS.

Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles

2019 ◽  
Author(s):  
Mona Lisa Delva ◽  
Linsen T. Samuel ◽  
Alexander Roth ◽  
Sercan Yalçin ◽  
Atul F. Kamath
Keyword(s):  
Postoperative Complications ◽  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
The United States ◽  
Femoral Osteotomy ◽  
Tibial Osteotomy ◽  
Complication Rates ◽  
Distal Femoral Osteotomy ◽  
Younger Patients ◽  
Functional Scores

AbstractKnee osteotomies show efficacy in slowing knee osteoarthritis progression and delaying the need for total knee arthroplasty in younger patients. Despite evolutions in indications, techniques, and hardware that have improved outcomes, longitudinal trends demonstrate a decline in high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) use. Unfortunately, knowledge of the current usage and complications associated with HTO and DFO is limited. The purpose of this study was to compare the preoperative demographics and early complication rates of HTO and DFO. We analyzed the HTOs and DFOs performed between 2006 and 2017 using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. We compared both groups for preoperative patient demographics (sex, age, race, body mass index [BMI]) and health status variables including functional scores, ASA (American Society of Anesthesiologists) scores, smoking status, and other comorbidities. Emergency and elective status of the patient case, length of hospital stay, operation time, and 30-day postoperative complications were also analyzed. After the exclusion criteria were applied, 321 HTO and 295 DFO patients were included in the final analysis. The HTO group had higher proportions of younger (p < 0.001) and male (p < 0.001) patients with higher BMI (p = 0.007). Racial profiles were similar between the two groups (p = 0.575). Preoperatively, those in the HTO group had more functional independence, better physical status scores, and fewer chronic conditions (p < 0.05). There were no statistically significant differences between HTO and DFO in operative time, postoperative complications, readmission, and reoperation. HTO patients, however, had shorter hospital stays (p < 0.001). Although there are differences in preoperative and operative characteristics of HTO and DFO, early postoperative complications are similar for both groups. Therefore, HTO and DFO can be considered safe and effective treatment options for younger patients with symptomatic unicompartmental knee osteoarthritis.

scholarly journals Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

2021 ◽  
Author(s):  
Marco-Christopher Rupp ◽  
Philipp W. Winkler ◽  
Patricia M. Lutz ◽  
Markus Irger ◽  
Philipp Forkel ◽  
...  
Keyword(s):  
Femoral Osteotomy ◽  
Common Finding ◽  
Fracture Type ◽  
Varus Malalignment ◽  
Distal Femoral Osteotomy ◽  
Closing Wedge ◽  
Increased Risk ◽  
Surgical Data ◽  
Technical Factors ◽  
Hinge Fracture

Abstract Purpose To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. Methods Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors’ institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. Results The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05). Conclusion Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. Level of evidence Prognostic study; Level IV.

How the orientation of osteotomy in biplanar lateral closed-wedge distal femoral osteotomy influences the rotational alignment of the knee in all dimensional planes

The Knee ◽  
2021 ◽  
Vol 29 ◽  
pp. 167-173
Author(s):  
Hiroshi Nakayama ◽  
Ryo Kanto ◽  
Tomoya Iseki ◽  
Shintaro Onishi ◽  
Shunichiro Kambara ◽  
...  
Keyword(s):  
Femoral Osteotomy ◽  
Rotational Alignment ◽  
Distal Femoral Osteotomy ◽  
Closed Wedge

scholarly journals Medial Closed Wedge Distal Femoral Osteotomy Using a Novel Plate With an Optimal Compression System

2021 ◽  
Author(s):  
Ryuichi Nakamura ◽  
Takenori Akiyama ◽  
Ryohei Takeuchi ◽  
Hiroshi Nakayama ◽  
Eiji Kondo
Keyword(s):  
Femoral Osteotomy ◽  
Distal Femoral Osteotomy ◽  
Compression System ◽  
Closed Wedge

scholarly journals Eight respectively nine out of ten patients return to sport and work after distal femoral osteotomy

2018 ◽  
Vol 27 (7) ◽  
pp. 2345-2353 ◽  
Author(s):  
Alexander Hoorntje ◽  
Berbke T. van Ginneken ◽  
P. Paul F. M. Kuijer ◽  
Koen L. M. Koenraadt ◽  
Rutger C. I. van Geenen ◽  
...  
Keyword(s):  
Return To Sport ◽  
Femoral Osteotomy ◽  
Distal Femoral Osteotomy

Plantar Fibromatosis: A Review of Primary and Recurrent Surgical Treatment

1995 ◽  
Vol 16 (9) ◽  
pp. 548-551 ◽  
Author(s):  
Keith L. Wapner ◽  
Prodromos A. Ververeli ◽  
John H. Moore ◽  
Paul J. Hecht ◽  
Carl E. Becker ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Major Complication ◽  
Primary Group ◽  
Split Thickness Skin Graft ◽  
Consecutive Series ◽  
Revision Procedure ◽  
Thickness Skin ◽  
Plantar Fibromatosis ◽  
Revision Operations

Plantar fibromatosis can be quite disabling to the patient, as well as a technical challenge to the surgeon. Patients who undergo previous local excisions and in whom aggressive recurrences develop are difficult to manage successfully. We present a consecutive series of five primary procedures on patients with painful plantar fibroma and seven revision operations on patients with recurrent plantar fibroma. The average follow-up was 47 months (range, 22–66 months) in the primary group and 40 months (range, 21–78 months) in the revision group. The overall results were satisfactory in four of the five primary operations, with only one recurrence. In the revision group, five of seven results were satisfactory with no recurrences. The major complication that led to unsatisfactory results was the development of a postoperative neuroma. In this article, we outline our present surgical techniques of wide primary excision and a staged revision procedure with delayed split-thickness skin graft closure. These techniques can be used successfully to manage this disabling, progressive disease.

scholarly journals Enhancing Safety in Epilepsy Surgery (EASINESS): Study Protocol for a Retrospective, Multicenter, Open Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Richard Drexler ◽  
Sharona Ben-Haim ◽  
Christian G. Bien ◽  
Valeri Borger ◽  
Francesco Cardinale ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Reference Values ◽  
Surgical Techniques ◽  
Mesial Temporal Lobe Epilepsy ◽  
Diagnostic Tools ◽  
Surgical Data ◽  
Mesial Temporal Lobe

Introduction: Optimizing patient safety and quality improvement is increasingly important in surgery. Benchmarks and clinical quality registries are being developed to assess the best achievable results for several surgical procedures and reduce unwarranted variation between different centers. However, there is no clinical database from international centers for establishing standardized reference values of patients undergoing surgery for mesial temporal lobe epilepsy.Design: The Enhancing Safety in Epilepsy Surgery (EASINESS) study is a retrospectively conducted, multicenter, open registry. All patients undergoing mesial temporal lobe epilepsy surgery in participating centers between January 2015 and December 2019 are included in this study. The patient characteristics, preoperative diagnostic tools, surgical data, postoperative complications, and long-term seizure outcomes are recorded.Outcomes: The collected data will be used for establishing standardized reference values (“benchmarks”) for this type of surgical procedure. The primary endpoints include seizure outcomes according to the International League Against Epilepsy (ILAE) classification and defined postoperative complications.Discussion: The EASINESS will define robust and standardized outcome references after amygdalohippocampectomy for temporal lobe epilepsy. After the successful definition of benchmarks from an international cohort of renowned centers, these data will serve as reference values for the evaluation of novel surgical techniques and comparisons among centers for future clinical trials.Clinical trial registration: This study is indexed at clinicaltrials.gov (NT 04952298).

scholarly journals BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

2021 ◽  
Vol 10 (23) ◽  
pp. 5665
Author(s):  
Helena Sophie Leitner ◽  
Reinhard Pauzenberger ◽  
Ines Ana Ederer ◽  
Christine Radtke ◽  
Stefan Hacker
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Positive Impact ◽  
Surgical Techniques ◽  
Study Cohort ◽  
Complication Rates ◽  
Impaired Wound Healing ◽  
Reconstruction Methods ◽  
Study Results ◽  
The Impact

Background: Breast reconstruction has a positive impact on body image and quality of life for women after experiencing the physically and psychologically demanding process of mastectomy. Previous studies have presented body mass index (BMI) as a predictor for postoperative complications after breast reconstruction, however, study results vary. This retrospective study aimed to investigate the impact of patients’ BMI on postoperative complications following implant-based breast reconstruction. Methods: All implant-based breast reconstructions performed at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Vienna from January 2001 to March 2018 were evaluated. A total of 196 reconstructed breasts among 134 patients met eligibility criteria. Demographic data, surgical techniques, as well as major and minor complications within a one-year follow-up period were analyzed. Results: Patients’ BMI did not show a significant impact on complication rates. The overall incidence of postoperative complications was 30.5% (40/131) of which 17.6% required reoperation. Impaired wound healing (18.3%), seroma (6.1%), hematoma (4.6%), capsular contraction (4.6%) and infection (3.8%) were the most common complications. Conclusion: In our study cohort, BMI was not associated with a significantly higher risk of complications. However, postoperative complications significantly increased with a longer operative time and resulted in an extended length of hospital stay.

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