Osteolysis following PE Wear of a Hastings Head on a Monoblock Hip Stem

We report a case of extended osteolysis, requiring a third revision of the left hip in an 85-year-old man 46 years after index operation. Major polyethylene (PE) wear occurred due to a missmatched combination of a bipolar Hastings head with a PE liner and head damage of the originally maintained stem. This case demonstrates that bipolar heads should not be used with PE cup liners since the respective bearing diameters cannot be guaranteed to match due to missing specifications. Furthermore, putting a Hastings head on an already damaged head of the stem should be omitted and rather the stem should initially be revised.

Age, body mass index, and osteoporosis are more predictive than imaging for adjacent-segment reoperation after lumbar fusion

Background: Adjacent-segment disease (ASD) is a well-described long-term complication after lumbar fusion. There is a lack of consensus about the risk factors for development of ASD, but identifying them could improve surgical outcomes. Our goal was to analyze the effect of patient characteristics and radiographic parameters on the development of symptomatic ASD requiring revision surgery after posterior lumbar fusion. Methods: In this retrospective cohort study, we identified patients who underwent lumbar fusion surgery and revision surgery from May 2012 to November 2018 using an institutional lumbar fusion registry. Patients having both pre- and post-operative upright radiographs were included in the study. Revision surgeries for which the index operation was performed at an outside hospital were excluded from analysis. Univariate analysis was conducted on candidate variables, and variables with P< 0.2 were selected for multivariate logistic regression. Results: Of the 106 patients identified, 21 required reoperation (29 months average follow-up). Age >65 years (OR 4.14, 95% CI 1.46–11.76, P= 0.008), body mass index (BMI) >34 (OR 1.13, 95% CI 1.04–1.23, P = 0.004), and osteoporosis (OR 14, 95% CI 1.38–142.42, P = 0.03) were independent predictors of reoperation in the multivariate analysis. Increased facet diastasis at fusion levels (OR 0.60, 95% CI 0.42–0.85, P = 0.004) was associated with reduced reoperation rates. Change in segmental LL at the index operation level, rostral and caudal facet diastasis, vacuum discs, and T2 hyperintensity in the facets were not predictors of reoperation. Conclusion: Age >65, BMI >34, and osteoporosis were independent predictors of adjacent-segment reoperation after lumbar spinal fusion.

The Role of Interventional Radiology in the Management of Late Postpancreaticoduodenectomy Hemorrhage

Objective. To explore the role of interventional radiology (IR) in the management of late postpancreaticoduodenectomy hemorrhage (PPH). Materials and Methods. Patients who had late PPH (occurring >24 h after index operation) managed by the IR procedure in our institution between 2013 and 2018 were retrospectively analyzed. Result. Hired patients who were diagnosed with grade B ( n = 10 ) and C ( n = 22 ) late PPH underwent 40 transcatheter arterial angiographies (TAA). The overall positive rate of angiography was 45.0% (18/40). Eighteen transcatheter arterial embolizations (TAEs) were performed, and the technical success rate was 88.89% (16/18). The rebleeding rate after embolization was 18.8% (3/16), and no severe procedure-related complications were recorded. The overall mortality of late PPH was 25.0% (8/32). Conclusion. Nearly half of hemorrhagic sites in late PPH could be identified by TAA. TAE is an effective and safe method for the hemostasia of late PPH in patients with positive angiography results.

Which Factors Increase the Risk of Reoperation After Meniscal Surgery in Children?

Background: Meniscal injuries in children can pose treatment challenges, as the meniscus must maintain its biomechanical function over a long lifetime while withstanding a high activity level. While the adult literature contains a plethora of studies regarding risk factors for failure of meniscal surgery, such reports are scarcer in children. Purpose: To determine the rate at which children undergoing meniscal surgery require subsequent reoperation as well as to define risk factors for reoperation in this population. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective institutional database of 907 first-time meniscal surgical procedures performed between 2000 and 2015 was reviewed. All patients were <18 years old. Demographic and intraoperative information was recorded, as were concurrent injuries or operations and subsequent procedures. Univariate analysis consisted of chi-square and independent-samples t tests. Multivariate logistic regression with purposeful selection was then performed to adjust for confounding factors. Results: The mean ± SD patient age was 13.2 ± 2.1 years, and 567 (63%) were male. The mean postoperative follow-up duration was 20.1 ± 10.1 months. Overall, 83 patients (9%) required repeat surgery at a mean of 23.2 months after the index operation. After adjustment for confounders in a multivariate model, meniscal repair resulted in 3.1-times higher odds of reoperation when compared with meniscectomy (95% CI, 1.2-8.3; P = .02), while white-white zone tears had 2.8-times lower odds of reoperation (95% CI, 1.01-7.7; P = .04) versus red-red and red-white zone tears. Conclusion: Approximately 9% of children undergoing meniscal surgery will require reoperation at a mean 23.2 months after the index operation. Repair carried approximately 3-times higher odds of reoperation than meniscectomy, while white-white zone tears had nearly 3-times lower odds of requiring repeat surgery when compared with tears in other zones.

Prediction for a planned relaparotomy in secondary peritonitis

Aims. To devise a scoring system for clinical variables related to positive findings at relaparotomy in secondary peritonitis. Methods. We have retrospectively studied 195 cases of patients after relaparotomy. According to the operation’s findings, the patients were divided into two groups: ‘relaparatomy unnecessary’ group A, ‘relaparotomy necessary’ group B. 6 factors (age, sex, leukocyte count, C reactive protein, time of symptoms to index operation, Mannheim Peritonitis Index) were evaluated in respect to their significance in decision making for relaparotomy. The predictive value for positive operation`s findings of these factors was evaluated by logistic multivariate regression analysis. According to this model a risk scoring system was created to support the decision whether to perform a relaparotomy. Results. Relaparotomy was unnecessary (Group A) for 154 (79,0%) patients, for 41 (21,0%) it was necessary (Group B). Comparing the groups A and B, we found a significant difference in patients’ mean age (54 v. 63 years, p=0,002), mean CRP level (133,2 v. 182,8 mg/L, p=0,025), mean time of symptoms to index operation (38,1 v. 67,1 hours, p=0,006) and mean MPI value (22,4 v. 29,4, p<0,0001). According to the above-mentioned predictors, a scoring system was devised: −0,17-(0,003×patient’s age years)+(0.153×time of symptoms to index operation hours)-(0,297×MPI)+(0,192×CRP mg/l). The score was 24,798±25,593 in group A and 36,572±32,543 in group B(p=0,028). Conclusions: Scoring system was devised to assist in creating treatment strategy after secondary peritonitis. If the score is ≥37, a planned relaparotomy should be performed. If the score is ≤24, other diagnostic and therapeutic tactics should be applied.

Prophylactic mesh placement of permanent stomas at index operation for colorectal cancer

INTRODUCTION Parastomal herniation occurs in 30–50% of colostomy formations. The aim of this study was to radiologically evaluate the mechanical defects at stoma sites in patients who had previously undergone a permanent colostomy with or without mesh at the index operation for colorectal cancer. METHODS A study was performed of all colorectal cancer patients (n=41) having an end colostomy between 2002 and 2010, with or without Prolene® mesh plication, with blinded evaluation of the annual follow-up staging computed tomography (CT) for stomal characteristics. The presence of parastomal hernias, volume, dimensions, grade of the parastomal hernia and abdominal wall defect size were measured by two independent radiologists, and compared with demographic and operative variables. RESULTS In those patients with radiological evidence of a parastomal hernia, Prolene® mesh plication significantly reduced the incidence of bowel containing parastomal hernias at one year following the procedure (p<0.05) and also reduced the diameter of the abdominal wall defect (p=0.006). CONCLUSIONS Prophylactic mesh placement at the time of the index procedure reduces the diameter of abdominal wall aperture and the incidence of parastomal hernias containing bowel. Future studies should use both objective radiological as well as clinical endpoints when assessing parastomal hernia development with and without prophylactic mesh.