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Background: Joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) are connective tissue disorders characterized by increased joint laxity, affecting musculoskeletal health and quality of life. In this study, we explored recent trends in surgical treatment of shoulder instability among patients with these disorders. Methods: We searched the PearlDiver Mariner database, which includes deidentified US all-payer claims data from 2010 to 2020. We used procedure and diagnostic codes for EDS and JHS to select patients. The primary outcome was the yearly trend in relative utilization of the following 4 shoulder instability procedures: arthroscopic stabilization, Latarjet coracoid transfer, open capsulolabral repair, and open capsulolabral shift. Results: Among 109,274 patients with EDS and 453,885 with JHS, 3.4% and 0.8% underwent shoulder instability procedures, respectively. Arthroscopic stabilization was the predominant treatment, with a mean utilization rate of 78% for EDS and 83% for JHS. Notably, the age at surgery increased for EDS patients but decreased for JHS patients. Female patients represented large proportions of those undergoing procedures in both the EDS group (83%) and the JHS group (77%). Conclusions: Our findings indicate a consistent preference for arthroscopic stabilization in treating shoulder instability in patients with EDS and JHS. The trends in age suggest shifts in treatment strategies, possibly influenced by advancements in nonoperative interventions or varying symptom severity. The higher proportion of female patients aligns with the known prevalence of connective tissue disorders in women. Future research should explore outcomes, complications, and specific EDS subtypes to guide optimal treatment strategies for these challenging connective tissue disorders.

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: As medical and recreational cannabis use continues to increase in prevalence across the United States, it is important to understand the impacts of sustained cannabis use on one’s health. Previous literature has shown the potential for cannabidiol products to aid in the improvement of some osteoarthritic symptoms. However, there is a paucity of literature examining the relationship between cannabis use and postoperative medical outcomes for end stage osteoarthritis management, including procedures such as foot and ankle arthrodesis. Therefore, the purpose of this study was to investigate the relationship between cannabis use and the incidence of medical complications within 90 days of foot or ankle arthrodesis. Methods: A retrospective review of a national insurance claims database was performed from 2010 to 2022. CPT codes were used to identify patients who underwent arthrodesis of the ankle, subtalar, talonavicular, calcaneocuboid, naviculo-cuneiform, midtarsal, tarsometatarsal, metatarsophalangeal, or interphalangeal joints. Of those patients, those with established diagnoses of cannabis use disorder, cannabis dependency, or cannabis addiction were identified using ICD-9 and -10 codes. This cannabis cohort was matched 1:4 on the basis of age, sex, and Charlson Comorbidity Index (CCI) to a control cohort without a history of cannabis use to remove potential confounding upon comparison. Demographic and comorbidity profiles, as well as medical and surgical post-operative outcomes were compared using Chi-square tests. Results: Out of 192,162 patients undergoing foot or ankle arthrodesis, 6,387 had a documented history of cannabis use. Compared to controls, the cannabis cohort was significantly younger (mean age 44.1 vs. 56.5; p< 0.001), exhibited a higher comorbidity burden (mean CCI 1.59 vs. 1.38; p< 0.001), and had a greater proportion of male patients (48.2% vs. 31.9%; p< 0.001). Post-matching for age, CCI, and sex, cannabis users demonstrated a significantly higher incidence of medical complications within 90 days of their index ankle fracture ORIF procedure. Notably, cannabis users exhibited elevated rates of various complications, including pneumonia, deep venous thrombosis, pulmonary embolism, myocardial infarction, stroke, surgical site infection, cardiac arrest, acute kidney injury, urinary tract infection, sepsis, and hypoglycemia compared to matched controls (all p< 0.001). Conclusion: Cannabis use is associated with increased incidences of many serious medical complications within 90 days of foot or ankle arthrodesis. These results may help better inform physicians and patients about the increased postoperative risks cannabis users may face, which may lead to the implementation of tailored perioperative care. Further, these results emphasize the need for further research on the molecular mechanisms of cannabis to understand the risk-benefit ratio between the therapeutic effects of cannabidiol for arthritic pain relief, and the adverse outcomes that may result following surgical intervention.

Category: Ankle; Trauma Introduction/Purpose: As medical and recreational cannabis use continues to increase in prevalence across the United States, it is important to understand how cannabis can impact health. Though prior studies have shown that cannabis use can result in delayed bone healing, there is a paucity of literature examining the relationship between cannabis use and postoperative medical outcomes following fracture fixation. Therefore, the purpose of this study was to investigate the relationship between cannabis use and the incidence of medical complications within 90 days of surgical fixation of ankle fractures. Methods: A retrospective review of a national insurance claims database was performed from 2010 to 2022. Patients who underwent open reduction and internal fixation (ORIF) procedures for medial malleolus fractures, lateral malleolus fractures, distal fibula fractures, bimalleolar fractures, and trimalleolar fractures were identified using CPT codes. Of those patients, those with established diagnoses of cannabis use disorder, cannabis dependency, or cannabis addiction were identified using ICD-9 and -10 codes. This cannabis cohort was matched 1:4 on the basis of age, sex, and Charlson Comorbidity Index (CCI) to a control cohort without a history of cannabis use to remove potential confounding upon comparison. Demographic and comorbidity profiles, as well as medical and surgical post-operative outcomes were compared using Chi-square tests. Results: Out of 788,702 patients undergoing ankle fracture open reduction and internal fixation (ORIF) during the study period, 46,105 had documented cannabis use. Cannabis cohort, compared to controls, exhibited significant differences: younger age (mean 38.8 vs. 52.7 years; p< 0.001), lower comorbidity-burden (mean CCI 1.58 vs. 1.68; p< 0.001), and a higher proportion of male patients (51.1% vs. 33.2%; p< 0.001). Following age, CCI, and sex matching, patients with cannabis use histories showed a significantly increased incidence of medical complications within 90 days post ankle fracture ORIF. Cannabis users displayed elevated rates of various complications compared to matched controls, including pneumonia, deep venous thrombosis, pulmonary embolism, myocardial infarction, stroke, surgical site infection, cardiac arrest, acute kidney injury, urinary tract infection, sepsis, and hypoglycemia (all p< 0.001). Conclusion: Cannabis use is associated with increased incidences of many serious medical complications within 90 days of ankle fracture fixation procedures. These results underscore the importance of eliciting cannabis use history during preoperative patient evaluations so that physicians and patients can be better informed about the increased postoperative risks they may face, and so tailored perioperative care can be appropriately implemented. Further, these results emphasize the need for further research on the molecular mechanisms of cannabis to explain interactions that may predispose heavy cannabis users to this profile of adverse surgical outcomes.

Category: Ankle; Ankle Arthritis Introduction/Purpose: Obesity is an ongoing public health epidemic with wide-ranging implications for orthopaedic surgery. Bariatric surgery has been shown to be an effective method for weight reduction. This retrospective cohort study aimed to compare rates of reoperation between patients who underwent primary ankle arthrodesis (AA) and those who underwent total ankle arthroplasty (TAA) after undergoing bariatric surgery. Methods: Utilizing data from PearlDiver, patients who received primary AA or TAA with prior history of bariatric surgery to a cohort without prior bariatric surgery were retrospectively analyzed for reoperations. Both cohorts were propensity-matched based on age, sex and Charlson Comorbidity Index in a 1:4 ratio. Indications for reoperation included revision, prosthetic joint infection (PJI), hardware removal, adjacent joint fusion, and local open reduction internal fixation (ORIF). Kaplan-Meier survival analysis and hazard ratios were calculated for five years after the procedure. Results: Of the 801 patients with prior history of bariatric surgery, 519 (65%) underwent AA, while 282 (35%) underwent TAA. At 5 years post-operatively, patients who had undergone AA showed a higher incidence of adjacent joint fusion if they had prior history of bariatric surgery (Hazard ratio: 1.79, 95% Confidence Interval: 1.23 - 2.61, P-value < 0.001). No differences in reoperation rates were observed for PJI, hardware removal and ORIF. At 5 years, patients who had undergone TAA with history of bariatric surgery showed no difference in the incidence of revision, PJI, hardware removal, ORIF and adjacent joint fusion as compared to patients who underwent TAA with no history of bariatric surgery. Conclusion: Our findings suggest that patients undergoing primary TAA displayed comparable reoperation rates regardless of prior bariatric surgery history over a five-year post-procedure period. In contrast, patients undergoing primary AA exhibited an increased risk of adjacent joint fusions if they had history of bariatric surgery, although the rates of reoperation due to PJI, ORIF, and hardware removal remained comparable. Notably, our results do not position a prior history of bariatric surgery as a significant determinant in reoperation rates. These insights offer valuable guidance for orthopedic surgeons navigating the complexities of surgical interventions in the context of bariatric surgery.

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: With the rising prevalence of cannabis consumption among individuals undergoing foot and ankle procedures, there is a critical need for a comprehensive investigation into the impact of cannabis use on post-operative outcomes. The shifting societal attitudes towards cannabis, coupled with legislative changes promoting increased accessibility, underscore the urgency of understanding the implications for both patients and surgeons. This study aims to address this gap in knowledge and provide insights that can guide pre-operative evaluations and post-operative care planning. Methods: Utilizing data from PearlDiver, patients who underwent interphalangeal fusion, arthrodesis, arthroscopy, total ankle arthroplasty, ankle fracture repair, lateral ankle ligament reconstruction, calcaneal tendon repair, bunionectomy and calcaneal osteotomy were identified. These patients with prior history of cannabis use were propensity-matched with a cohort without prior history of cannabis use based on age, sex and Charlson Comorbidity Index in a 1:4 ratio. Both cohorts were evaluated for 90-day occurrence of medical complications using univariate analysis. Results: In this study, we matched 59,797 patients with a history of cannabis use undergoing foot or ankle procedures with 239,086 without such history. Those with prior cannabis use showed significantly elevated rates of medical conditions compared to controls: pneumonia (6.1% vs. 2.2%, p < .001), deep vein thrombosis (1.5% vs. 0.8%, p < .001), pulmonary embolism (0.4% vs. 0.2%, p < .001), myocardial infarction (1.6% vs. 0.5%, p < .001), stroke (1.8% vs. 0.8%, p < .001), surgical site infections (4.0% vs. 2.2%, p < .001), acute kidney injury (6.8% vs. 3.0%, p < .001), urinary tract infections (9.0% vs. 3.5%, p < .001), sepsis (4.6% vs. 2.0%, p < .001), and hypoglycemia (1.2% vs. 0.5%, p < .001). Conclusion: This study highlights a compelling correlation between prior cannabis use and heightened risks of medical complications post foot and ankle surgeries. The findings emphasize the imperative for healthcare professionals to include cannabis use history in pre-operative assessments and post-operative care planning. Acknowledging the evolving landscape of cannabis use among surgical patients, further research is essential to refine clinical approaches and enhance patient outcomes in this context.

Background: Revision total shoulder arthroplasty (TSA) for prosthetic joint infection (herein, “septic revision TSA”) requires more time and resources compared with revision in the absence of infection (“aseptic revision TSA”). Physician compensation should accurately reflect this greater burden. In this study, we assessed whether physician compensation for septic revision TSA is proportionate to that for aseptic revision TSA. Methods: The National Surgical Quality Improvement Program database was queried from 2006 to 2021 to identify cases of aseptic and septic revision TSA. Work relative value units (wRVUs), operative time, wRVUs per minute, and compensation per hour were compared between aseptic and septic cases. Univariate and multivariate analyses were conducted to assess wRVU adequacy for septic revision TSA. The wRVU-to-dollar conversion factor was obtained from the US Centers for Medicare & Medicaid Services, and wRVU dollar valuations were calculated. P values

Introduction: Marfan Syndrome (MFS) presents unique challenges for total joint arthroplasty (TJA), yet its long-term outcomes are not well-documented. This study aimed to assess whether MFS patients are more likely to require revision compared to those without MFS and to identify specific revision causes with elevated risks. Methods: We performed a retrospective analysis using a national claims database to find patients who had undergone total knee arthroplasty (TKA) or total hip arthroplasty (THA). MFS patients were matched to non-MFS patients in a 1:4 ratio based on age, sex, and Charlson Comorbidity Index (CCI). We used Kaplan-Meier analyses and Cox proportional hazards models to evaluate the cumulative incidence and risks of revision for both groups. Results: MFS patients who had THA were at a higher risk of needing revision due to instability (HR: 4.82; 95 % CI: 1.07–21.62; P = 0.039) compared to non-MFS patients. However, there were no significant differences in revision risk for all causes or for revisions due to periprosthetic joint infection, mechanical loosening, or periprosthetic fracture after THA between MFS and matched control patients. Similarly, no significant differences were found in revision risk after TKA. Discussion: Our matched cohort study indicates that MFS patients have similar risks of all-cause revision after TJA compared to non-MFS patients. Nonetheless, MFS patients face nearly a fivefold increased risk of instability five years after THA. Further research should explore whether this risk can be mitigated through changes in surgical technique.