Rodney D. Terrell

Incidence of Acute Postoperative Infections Requiring Reoperation After Arthroscopic Shoulder Surgery

Background: An acute infection after arthroscopic shoulder surgery is a rare but serious complication. Previous studies estimating the incidence of infections after arthroscopic surgery have been conducted, but the majority of these had either relatively small study groups or were not specific to shoulder arthroscopic surgery. Purpose: To investigate the incidence of acute infections after arthroscopic shoulder surgery and compare infection rates by age group, sex, geographic region, and specific procedures. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of a large insurance company database was performed for all shoulder arthroscopic surgeries performed in the United States between 2004 and 2009 that required additional surgery for infections within 30 days. The data were stratified by sex, age group, and region. Data were also stratified for specific procedures (capsulorrhaphy, treatment for superior labrum anterior-posterior tears, claviculectomy, decompression, and rotator cuff repair) and used to assess the variation in the incidence of infections across different arthroscopic shoulder procedures. Linear regression was used to determine the significance of differences in the data from year to year. χ2 analysis was used to assess the statistical significance of variations among all groups. Poisson regression analysis with exposure was used to determine significant differences in a pairwise comparison between 2 groups. Results: The total number of arthroscopic shoulder surgeries performed was 165,820, and the number of infections requiring additional surgery was 450, resulting in an overall infection rate of 0.27%. The incidence of infections varied significantly across age groups (P < .001); the infection rate was highest in the ≥60-year age group (0.36%) and lowest in the 10- to 39-year age group (0.18%). The incidence of infections also varied by region (P < .001); the incidence was highest in the South (0.37%) and lowest in the Midwest (0.11%). The incidence of infection treatments was also significantly different between different arthroscopic procedures (P < .01) and was highest for rotator cuff repair (0.29%) and lowest for capsulorrhaphy (0.16%). The incidence did not significantly vary by year or sex. Conclusion: The overall infection rate for all arthroscopic shoulder procedures was 0.27%. The incidence was highest in elderly patients, in the South, and for rotator cuff repair. The incidence was lowest in young patients, in the Midwest, and for capsulorrhaphy. In general, shoulder arthroscopic surgery in this study population had a low rate of reoperation in the acute period.

Comparison of practice patterns in total ankle replacement and ankle fusion in the United States.

Background: Although tibiotalar fusion has historically been considered the gold standard treatment for end-stage arthritis of the ankle, the performance of total ankle replacement appears to be gaining favor as improved outcomes have been observed with new implant designs and surgical techniques. The purpose of this study was to compare trends and demographics in the performance of ankle fusion and total ankle replacement in the United States. Methods: The Current Procedural Terminology (CPT) codes of patients undergoing ankle fusion and total ankle replacement were searched using the PearlDiver Patient Record Database, a national database of orthopaedic patients. The CPT codes for open ankle arthrodesis (27870), arthroscopic ankle arthrodesis (29899), and total ankle replacement (27700, 27702) were searched for the years 2004 to 2009 to identify relative changes in the performance of ankle fusion and replacement over time. Results: The performance of ankle fusion was unchanged during the 6-year study period. In contrast, an increase in total ankle replacement was observed, from 0.63 cases per 10 000 patients searched in 2004 to 0.99 cases per 10 000 patients in 2009 (P < .05). Both ankle fusion and total ankle replacement were performed most commonly in patients aged 60 to 69 years (P < .05). Although an even gender distribution was observed in patients undergoing total ankle replacement, open and arthroscopic fusion were more commonly performed in males (P < .05). With regard to regional distribution, open and arthroscopic fusion were most commonly performed in the western region of the United States, whereas total ankle replacement was performed most frequently in the Midwest (P < .001). Conclusions: In the population studied, the performance of total ankle replacement increased 57% from 2004 to 2009 and was performed equally in male and female patients when compared to ankle fusion, which was more often performed in males and was unchanged with time. Level of Evidence: Level IV, cross-sectional study.

The Effect of Corticosteroid Administration on Soft-tissue Inflammation Associated With rhbmp-2 Use in a Rodent Model of Inflammation

Study Design. In vivo rodent model. Objective. Investigate the effect of systemic corticosteroid administration on soft-tissue inflammation after local delivery of recombinant human bone morphogenetic protein-2 (rhBMP-2). Summary of Background Data. Corticosteroid use in cases of soft-tissue inflammation associated with the use of rhBMP-2 has been reported in clinical studies, but the effectiveness of its use and appropriate timing remain unclear. Methods. Absorbable collagen sponges were implanted with control or rhBMP-2 into the lumbar region of rats subcutaneously and intramuscularly. Four groups were studied: group I, control sponge only; group 2, BMP-2 sponge only; group III, BMP-2 sponge and preoperative intraperitoneal methylprednisolone (MPSS); group IV, BMP-2 sponge with MPSS given on day 2. Using magnetic resonance imaging, inflammation was assessed in terms of soft tissue edema volume at 0, 2, 4, and 7 days. Rats were sacrificed after 7 days for gross and histological analysis. Results. The peak mean intramuscular inflammatory volume occurred on day 2 in all groups. Group II (BMP-2 without MPSS) had a significantly higher peak mean inflammatory volume (405.46 mm3) on day 2 than that of groups I (266 mm3), III (278 mm3), and IV (291 mm3) (P = 0.001). No significant difference in intramuscular soft-tissue inflammation was observed between the control group and the groups receiving MPSS on day 0 or day 2 at any time point. No differences in the area of inflammatory cell infiltrate surrounding the sponge was observed histologically, after sacrificing them, in groups treated with BMP-2. Conclusion. Systemic MPSS administration reduced soft tissue edema associated with rhBMP-2 as measured by magnetic resonance imaging, but no effect was observed on the histological area of inflammation. Further studies are required to elucidate if there is any benefit to the use of corticosteroid administration in reducing the area of inflammation associated with the use of rhBMP-2.

The costs associated with the evaluation of rotator cuff tears before surgical repair.

BACKGROUND Patients undergoing rotator cuff repair typically have a diagnostic evaluation and trial of nonoperative therapy before surgery. Recent studies have evaluated the cost-effectiveness of surgery, but none have attempted to estimate the costs associated with the preoperative evaluation. This study used available data to examine major expenditures during the preoperative period. MATERIALS AND METHODS We conducted a search using an insurance company database to identify patients undergoing rotator cuff repair from 2004 to 2009. Patients were identified by the common Current Procedural Terminology codes for rotator cuff repair. The associated charge codes for the 90-day period before surgery were categorized as outpatient physician visits, diagnostic imaging studies, injections, physical therapy, laboratory and other preoperative studies, prior surgeries, and miscellaneous. The frequency of each code and the associated charges were noted. RESULTS In total, 92,688 patients were identified in the study period. A total of

Analysis of Relationship between Paraspinal Muscle Fatty Degeneration and Cervical Spine Motion Using Kinetic Magnetic Resonance Imaging

161,993,100 was charged during the preoperative period, for an average of

Hospital Charges and Practice Patterns for General and Regional Anesthesia in Arthroscopic Anterior Cruciate Ligament Repair.

1,748 per patient. Diagnostic imaging charges totaled

The effect of bone morphogenetic protein-2 injection at different time points on intervertebral disk degeneration in a rat tail model.

104,510,646 (65%); injections,

Trends in the surgical treatment of articular cartilage defects of the knee in the United States.

5,145,227 (3%); outpatient visits,

Incidence of Postoperative Infections Requiring Reoperation After Arthroscopic Knee Surgery

29,723,751 (18%); physical therapy,

The Changing Demographics of Knee Dislocation: A Retrospective Database Review

13,844,270 (8.5%); preoperative studies,