OSP Journal of Orthopaedics

Purpose: The implications of performing hip arthroscopy in obese and non-obese patients have not been well documented in recent literature. Thus, this study assesses 30-day surgical outcomes between obese and matched non-obese patients using a large national database.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify hip arthroscopy patients from 2008-2016. Inclusion criteria included patients who underwent hip arthroscopy for femoroplasty, acetabuloplasty, arthroscopy with labral repair, and arthroscopy with debridement/shaving of articular cartilage. Patients were categorized as obese/non-obese by BMI of 30 kg/m2 and matched with propensity scores based on demographics (n=830). The following outcomes were assessed: 1) operative time, 2) surgical site infection, 3) wound dehiscence, 4) urinary tract infection, 5) postoperative pneumonia 6) bleeding necessitating transfusion, 7) deep vein thrombosis, 8) unplanned reoperation, and 9) 30-day readmission. T-tests and chi-square were used to compare operative time and 30-day complications between the groups.

Results: The cohorts had a significant difference in operative times (obese = 94.9 minutes vs. non-obese = 103.4 minutes, p<0.001), although there was a difference in incidence of procedures between cohorts. However, there were no significant differences in any other 30-day surgical complication between the obese and the non-obese patient groups.

Conclusions: Our results highlight the safety of hip arthroscopy in obese patients. With this information, surgeons reluctant to operate on obese patients for fear of complications will have more data to mitigate their concerns, giving this population greater benefit from appropriate therapeutic measures.

Background: Adolescent idiopathic scoliosis (AIS) results in three-dimensional malrotation that cannot be fully characterized on 2-view radiographs. Pedicle screw placement is the preferred method to safely and effectively reduce axial rotation, and screw placement at the scoliotic apex has been considered paramount.

Purpose:  To evaluate axial rotation correction on CT in AIS patients undergoing pedicle screw placement at the thoracic curve apex. To evaluate whether proximity and number of pedicle screws near the curve apex correlates with improved correction of axial rotation.

Methods: Retrospective review was made of patients <18 years with AIS and primary thoracic curvature who underwent surgery and had preoperative and postoperative CTs. During a 17-month interval, 41 patients were included (34 F/7M) between the ages of 12 and 17 (average=14.2) years. Operations were performed at single institution by single pediatric orthopedic surgeon. Average correction in axial rotation on CT was calculated using the Ho method. Spearman correlation coefficient was calculated to assess the relationship between reduction in axial rotation and the number of screws concentrated near the apex or total number of screws.

Results: Average change in axial rotation after pedicle screw placement was 5 degrees (38% change). No statistically significant correlation was found between change in axial rotation and number of screws at the apex, location of closest screw located above or below the apex, and number of screws located above or below the apex.

Conclusion: If pedicle instrumentation at the scoliotic apex does not contribute to axial correction then this level could be avoided, thereby decreasing costs and complications related to screw breech.

Level of Evidence: Therapeutic Study - Level III