Omar Tarawneh

Introduction: Total shoulder arthroplasty (TSA) and reverse TSA (rTSA) are successful treatments for end-stage shoulder arthritis. However, it is unknown whether prior arthroscopy is associated with an increased risk for revision surgery. This study investigates if undergoing a shoulder arthroscopy in the year prior to primary arthroplasty increases risk of revision surgery within 2 years. Methods: Patients who underwent TSA or rTSA between 2005 and 2017 were identified in a natinal claims database and stratified into two cohorts: (1) individuals with a history of shoulder arthroscopy prior to arthroplasty and (2) individuals with no documented history of arthroscopy prior to arthroplasty. These cohorts were propensity matched based on demographic and comorbidity factors. Univariate analysis was used to determine differences in revision rates, aseptic loosening, periprosthetic fracture, and infection between the two cohorts. Results: Seven hundred and eighty-eight patients were successfully matched from the two cohorts. Revision surgery (3.4% vs. 1.4%, p = 0.001) and aseptic loosening (2.2% vs. 0.8% p = 0.021) were significantly more common in the arthroscopy cohort. Periprosthetic fracture and periprosthetic infection were not found to be significantly different between cohorts. Discussion: Shoulder arthroscopy in the year prior to shoulder arthroplasty is associated with an increased risk of complications, including revision and aseptic loosening.

Purpose Across orthopedic subspecialties, significant racial disparities have been identified with regard to postoperative outcomes. Despite these findings among adult patients, the literature assessing these disparities within pediatric orthopedics is limited. The purpose of this study was to determine the independent predictors for unplanned readmission following surgical treatment of developmental dysplasia of the hip. Methods Pediatric patients undergoing hip dysplasia surgery from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Two patient groups were defined: patients who had unplanned hospital readmission within 30 days of surgery and patients who were not readmitted. Clinical characteristics assessed included gender, race, and American Society of Anesthesiologists (ASA) class. Risk factors for complications were assessed using bivariate and multivariate analysis. Results Of 6561 pediatric patients undergoing surgical treatment for hip dysplasia, 540 (8.2%) had unplanned readmission. On bivariate analysis, non-white race (Black, Asian, Hispanic, American Indian, and Native Hawaiian), an ASA class of III, IV, or V, pulmonary, renal, neurological, and gastrointestinal comorbidities, as well as immune disease, steroid use, and nutritional support were significantly associated with unplanned readmission (p < 0.05 for all). After controlling for confounding variables on multivariate analysis, non-white race (OR 1.46; p = 0.042) and ASA class of III-V (OR 2.21; p = 0.002) were found to be independent predictors for readmission. Conclusion Clinicians should be advised of the increased readmission rates observed in non-white patients and those of higher ASA scores. Further work is needed to combat existing disparities within pediatric orthopedics.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic strained the United States healthcare system, and associated policies resulted in the postponement or cancellation of many elective surgeries. While most orthopaedic surgeons are aware of how the pandemic affected their patients’ care, broader national trends in the operative treatment of orthopaedic knee pathology are poorly characterized. Therefore, the purpose of this study was to identify trends in orthopaedic knee procedures during the COVID-19 pandemic. Methods: The TriNetX database was queried for orthopaedic knee procedures performed from March 2018 to May 2021. Procedures were classified as arthroplasty (total knee arthroplasty (TKA), revision total knee arthroplasty) or non-arthroplasty (tendon or ligament repair, fracture fixation). Procedural volume per healthcare organization was determined over five seasons from March 2020 to May 2021 and compared to overlapping pre-pandemic periods from March 2018 to May 2019. Descriptive analysis was performed, and comparisons were made using a Student’s T-test. Results: Compared to the pre-pandemic period, there were significant decreases in primary TKA (p=0.016), femoral or entire tibial component revision TKA (p=0.005), and open treatment of femoral shaft fractures (p=0.007) in spring 2020. Procedural volume returned to baseline in summer 2020 through winter 2021. In spring 2021, primary TKA (p=0.017) and one component revision TKA (p=0.003) increased compared to the pre-pandemic period. Conclusion: The greatest decrease in knee procedures occurred early in the pandemic. Rates of these procedures have since rebounded, with some exceeding pre-pandemic levels. Hospitals are now better able to accommodate orthopaedic surgical volume while continuing to care for patients with COVID-19.

The author list of this article has been corrected at the request of the authors. Second author Kevin Cho and third author Omar Tarawneh were erroneously omitted from the submitted manuscript and this error was not noticed until after publication. As stated by the submitting author, "The reason these two individuals had their names left off is because the draft that was sent to me initially to be uploaded to Cureus did not have the updated title page attached. I therefore did not have the complete author list and I was given the final title page after completing the submission process. I again apologize for this issue."

Background: Neuromuscular conditions, such as cerebral palsy, are the most common motor disabilities in the pediatric population. Children with these conditions frequently have accompanying hip deformities that require pelvic and femur osteotomy to correct the spastic hip dislocations. However, postoperative pain management remains an elusive and challenging problem. The purpose of this study was to determine whether postoperative use of epidural analgesia in patients with neuromuscular conditions provided similar outcomes with regard to pain scores, length of stay, duration of foley placement, duration of pain control, and complications as compared to traditional pain management regimens. To our knowledge, this is the first study comparing the use of epidural analgesia to conventional pain relief modalities following hip reconstruction in patients with neuromuscular conditions. Methods: A retrospective cohort study was performed using records of pediatric patients with neuromuscular conditions treated at our tertiary care center between January 2009 and December 2019. Patients with neuromuscular conditions treated with epidural or non-epidural analgesia for pain relief following unilateral or bilateral proximal femoral osteotomies, pelvic osteotomies, or open hip reduction were eligible for study inclusion. Multiple linear regression was used to determine differences in length of stay, pain score, pain modality, duration of Foley placement, and complications between the two cohorts. Results: Seventy patients met the inclusion criteria for the study. In all, 58 patients underwent unilateral procedures, of which 30 (52%) received epidural analgesia, and 28 (48%) received non-epidural pain control modalities. Demographic and baseline characteristics were similar among the cohort, except for BMI, which varied slightly. Average pain scores and pain control duration were not statistically different between the pain control modalities. After controlling for demographics, procedure, and immobilization type, the epidural group experienced significantly increased length of stay (+3.18 days, P=0.032) and duration of Foley placement (+1.04 days, P=.013). Complication rates between the two groups were not statistically significant. Conclusions: The use of epidural analgesia in children with neuromuscular conditions was associated with comparable pain scores, despite the increased length of stay and duration of Foley placement. No statistically significant difference in complication rates was observed between patients receiving epidural anesthesia and those receiving traditional pain modalities.

Objective: The present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry.Methods: The National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients’ data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5.Results: Both univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. ‘Severely frail’ patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21–35.44) for 30-day mortality, 3.02 (95% CI, 1.97–4.56) for major complications, and 2.94 (95% CI, 2.32–4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality.Conclusion: Increasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.

Multinodular and vacuolating neuronal tumor (MVNT) is a rare benign brain lesion, commonly found in middle-aged adults. The patients experience a range of symptoms from being asymptomatic to epileptic seizures, with headache being the most common symptom. Here we report a case of an incidental diagnosis of MVNT in a young female. A 25-year-old female with a past medical history of occasional headaches without seizures or any focal neurological deficit presented after a motor vehicle rollover. The MRI brain revealed an incidental finding of a subcortical lesion in the right parietal lobe with T2-FLAIR (fluid-attenuated inversion recovery) hyperintensity between the cystic portions, indicative of a possible MVNT, with a less probable chance of dysembryoplastic neuroepithelial tumor based on the subcortical location of the lesion. No neurosurgical intervention was recommended. With one-year follow-up, no changes were noted on neuroimaging, and the patient remained stable without any neurological symptoms. The MVNT is a rare brain lesion that presents with benign features. In patients with epileptic symptoms, surgical resection of the lesion can be curative. However, in asymptomatic patients, careful monitoring may be sufficient, as described in this case.

Despite their devastating nature, injuries due to tree-related- traumas are sparsely reported in the literature. Over the last several years, the incidence of tree-related traumatic injuries presenting to our level one trauma center, in Westchester, New York, has been concerning. The present study was undertaken to evaluate the clinical presentation, injury pattern, and outcomes of tree-related neurotrauma at our institution. In addition, we describe the injury pattern and medical management of several relevant cases of tree-related neurotrauma. We conducted a retrospective analysis of tree-related neurotrauma over a five-year period from January of 2014 to March of 2019 at Westchester Medical Center (WMC) and Maria Fareri Children’s Hospital, a level one trauma center. Patients presenting with neurotrauma that necessitated neurosurgical care were eligible for inclusion in this case series. Tree-related injury was defined as any trauma that was sustained as a direct result of collision with a tree. We identified 21 patients who sustained tree-related trauma. The cohort age ranged from 15 to 68 (mean=38 years). Injuries included seven skull fractures, four cases of subdural hematoma (SDH), six cases of intracranial hemorrhagic contusion, 14 spinal fractures, three cases of epidural hematoma (EDH), one case of spinal cord contusion, three vascular injuries, one case of dural laceration, and one case of pneumocephalus, with several patients suffering multiple injuries. Of the 21 patients, seven were female, and 12 were injured when their motor vehicle struck a tree. All but four patients were taken to the operating room for neurosurgical treatment, and nine of 21 patients were taken emergently to the operating room upon arrival. The potential for serious head injuries with long-term neurologic sequelae exists with tree-related trauma. Clinicians should be advised of the challenging management of injuries secondary to tree-related trauma, and a greater emphasis should be placed on raising awareness of these accidental, but devastating injuries. Finally, a great majority of these injuries can be prevented or reduced in severity through helmet use and by adhering to safety guidelines.