Surgical Complications

Management of spinal surgical complications, including surgical site infections, symptomatic hematoma, and neurological deficits across degenerative and oncological procedures.

Overview

Major surgical and medical complications occur in 11.6% of adults treated with high-dose rhBMP-2 [1]. In the context of multilevel en bloc spondylectomy for thoracic and lumbar tumors, complication rates are high, though most patients recover from these adverse events [2]. Surgical site complications requiring readmission or reoperation are classified as major complications [3].

Complication profiles vary significantly by procedure and patient factors. In biceps tenodesis, the early complication rate is slightly higher for open techniques compared to arthroscopic approaches, though the number needed to treat for this difference is high [4]. For primary shoulder arthroplasty, increasing preoperative anemia severity correlates with higher postoperative medical and surgical complications, while postoperative transfusions are associated with elevated rates of medical complications, surgical complications, and 90-day mortality [7]. Conversely, the risk of complications following surgical treatment for shoulder instability remains relatively low, despite increased risks associated with specific technique selection [43].

Specific clinical contexts demand heightened vigilance. Closed incision negative-pressure wound therapy (ciNPWT) is clinically effective for high-risk incisions, though specific indications continue to be defined [20]. In total elbow arthroplasty, thorough knowledge of potential complications and surgical technique optimizes outcomes, with higher complication rates observed in trauma indications compared to inflammatory arthropathy and in more complex elbow arthroscopy cases [21, 22, 25]. Systematic reviews of articular distal humeral fracture fixation remain limited by their reliance on author-reported complications [23], and complication rates for total tumor resection of chondrosarcoma and chordoma in the thoracic and lumbar spine are similar [44].

Anatomy & Pathophysiology

Osseous and Biomechanical Integrity

L4–5 dislocation may represent a variant of lumbosacral (L5-S1) dislocation resulting from hyperextension injury [42], though the biomechanics of the lumbar spine differ with each individual [42]. In the context of thoracolumbar fractures, traumatic intervertebral disc injury contributes to loss of correction and is closely associated with accelerated disc degeneration [95]. For osteoporotic vertebral compression fractures, the height and volume restoration capabilities of Tektona® require proof via further biomechanical tests and clinical studies [84]. Regarding fixation strategies, short-segment fixation across the injured vertebra (6s) provides results comparable to short-segment fixation (4s) while causing less trauma [99]. In patients undergoing long fusion to the sacrum, realignment based on T4-L1-Hip Axis targets may lead to fewer mechanical failures [105]. Additionally, posterior superior iliac spine height has a large impact on pedicle screw placement in the lower lumbar spine [103].

Facet Joint Dynamics and Degeneration

The biomechanics of the lumbar spine may differ with each individual [42], and less facetectomy may reduce the risk of biomechanical deterioration and consequently, that of failed back surgery syndrome [68]. A facet angle greater than 45 degrees at the L4-5 level is associated with failure of primary decompression for lumbar facet cysts [102], as are larger amounts of fluid in the facet joints [102]. Biomechanical effects afford nearly sufficient spine support and gentle adjacent segment stress after rod fracture in a worst-case scenario of the thinnest PS of the SHE rod system [72].

Kinematics, Alignment, and Surgical Positioning

Orthopaedic surgeons should be aware of pathophysiology and related risks associated with spine surgery in the prone position [77]. Patients with multilevel fusions had more abnormal spinal sagittal balance and a higher risk of dislocation despite higher baseline and postoperative acetabular anteversion [96]. A larger preoperative cervical curvature can help reduce the occurrence of axial symptoms after posterior cervical open-door laminoplasty [98], and early postoperative functional exercises can also help reduce the occurrence of axial symptoms after posterior cervical open-door laminoplasty [98]. Decompression coupled with dynamic stabilization techniques can more effectively alleviate postoperative lumbar stiffness and functional impairment compared to traditional decompression combined with rigid fusion surgery [94].

Neural, Soft Tissue, and Adjacent Segment Risks

PPS injury produces alterations in glenohumeral kinematics with implications for glenohumeral joint instability, increased glenohumeral joint loading, and potential joint damage [97]. Future measures for fibrous dysplasia of the cervical spine should emphasize maintenance of the integrity of the spinal cord and use only a minimum amount of traction [104]. A personalized risk calculator was developed to assess the risk of proximal junctional kyphosis after adult spinal deformity surgery based on novel and modifiable clinical features [100]. Robotic-assisted spine surgery faces challenges such as registration errors, trajectory inaccuracies, and technical failures [101]. Physical examination of the spine includes inspection, palpation, range of motion testing, and neurologic evaluation to identify spinal pathology, nonspinal conditions, and signs of symptom magnification [93].

Classification

High-Dose rhBMP-2: Major surgical and medical complications occurred in 11.6% of patients treated with high-dose rhBMP-2 for adults [1].

Spinal Fusion and Instrumentation: Postoperative complications in spinal fusion and instrumentation for degenerative lumbar scoliosis are multifactorial, related to operation time, ASA class, insulin-dependent diabetes, and steroid use for chronic condition [58].

Total Knee Arthroplasty: The incidence of major complications with hinged total knee arthroplasty is much higher than with other types of total knee arthroplasty and arthrodesis [71].

Scapular Fractures: The current classification for scapular fractures after reverse shoulder arthroplasty has only moderate reliability [57].

Proximal Humeral Fractures: Scientific literature on surgically-managed proximal humeral fractures uses different terms to describe complications, resulting in a lack of agreement on adverse event terminology due to the absence of approved definitions [49].

Articular Distal Humeral Fracture Fixation: The systematic review on complications of articular distal humeral fracture fixation was limited to capturing only complications reported as such by the individual authors of the included manuscripts [23].

Total Joint Replacement: Both the Clavien-Dindo classification and Comprehensive Complication Index appear valid and applicable to patients undergoing total joint replacement [50].

Hand Surgery: A point-scoring system has been developed to predict risk for general postoperative complications after hand surgery [51], and patients classified as ASA class III or IV were identified to be at a significantly increased risk of complications following elective hand surgery [52].

Post-Tuberculosis Kyphosis: Clinical classification systems established for post-tuberculosis kyphosis facilitate precise risk stratification and enable targeted preoperative interventions to mitigate surgical risks and enhance surgical outcomes [35].

Other Considerations: Multilevel en bloc spondylectomy for tumors of the thoracic and lumbar spine is associated with a high complication rate [2]. Higher complication rates are observed after more complex elbow arthroscopy in adult and pediatric patients [22]. The rate of complications after hip arthroscopy is in line with complication rates after open surgical dislocation using the same classification system [34]. Thirty-seven percent of adverse events were reclassified by the CEC in spine surgery, with the large majority of adverse event reclassifications being an upgrade in the level of severity or a designation of greater relatedness to the surgery or device [47]. Current evidence suggests that some types of hand surgery may be done outside the operating theatre without increasing the risk of infection, although the evidence quality is poor [53].

Clinical Presentation

Major Complication Rates: High-dose rhBMP-2 in adults is associated with major surgical and medical complications occurring in 11.6% of patients [1]. Multilevel en bloc spondylectomy for thoracic and lumbar spine tumors carries a high complication rate [2]. Conversely, complications following anterior lumbar surgery are rare problems [14], and adverse events associated with anterior cervical spine surgery are infrequent but can be serious and potentially life-threatening [11].

Specific Complication Profiles: Symptomatic postoperative epidural hematomas and postoperative seromas are rare but potentially grave complications [8]. Paradoxical cerebral embolism is a rare complication complicating major orthopaedic operations [9]. Transient bilateral sciatic nerve palsy is a potential complication following beach chair positioning [31]. In distal biceps tendon repair, various patient demographics, medical comorbidities, and surgical factors predict short-term complications [6]. Increasing severity of preoperative anemia correlates with higher postoperative medical and surgical complications after primary shoulder arthroplasty [7], as does the receipt of postoperative transfusions, which presents elevated rates of medical complications, 90-day mortality, and surgical complications [7].

Wound and Neurovascular Recognition: Wound complications in total knee arthroplasty require prompt management when they occur [10]. Neurovascular complications of knee arthroscopy require early recognition to initiate prompt evaluation and treatment [12]. Postoperative complications after ankle fracture surgery are relatively rare, but their treatment can lead to considerable morbidity [13]. The majority of complications following elbow arthroscopy are minor and likely do not affect the clinical outcome [32]. Surgical site complications requiring readmission or reoperation should be considered major complications [3].

Diagnostic Differentiation and Imaging: The timing of symptoms, imaging results, and the development of atypical symptoms help distinguish Guillain-Barré syndrome from other postoperative spinal complications [5]. Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty (0.2%) [16].

Systemic and Late Presentations: A systematic approach to treatment is required for adult patients presenting with late or chronic complications after spinal surgery [29]. Early diagnosis and emergent surgical intervention promote better outcomes for acute perforated peptic ulcer after elective spine surgeries [33]. Prompt diagnosis and repair of false aneurysm of the popliteal artery prevents limb-threatening complications [36]. Recognition of the presenting features of acute colonic pseudo-obstruction is important to facilitate prompt initiation of treatment [37].

Investigations

Plain radiography: Routine immediate postoperative radiographs after shoulder arthroplasty are often of poor quality and rarely identify unknown complications (0.2%) [16]. In the absence of specific indications, routine PACU radiographs may similarly result in poor-quality images [78]. For aseptic loosening in total hip arthroplasty, careful evaluation of serial radiographs remains the cornerstone of diagnosis [73]. Regarding the iBP elbow prosthesis, many patients exhibit radiolucencies, creating a discrepancy between clinical signs and radiological results that warrants structural follow-up [67]. In pediatric patients, routine early postoperative radiographs after implant removal are overutilized, rarely change management, and provide no clinical benefit for most cases [70]. Findings regarding delayed- and non-union following opening wedge high tibial osteotomy are limited by unblinded surgeon review of radiographs and unknown patient selection criteria [61]. Intraoperative femoral fractures during cemented hemiarthroplasty for femoral neck fractures do not adversely affect radiographic outcomes postoperatively [55].

MRI: Early use of MRI provides valuable information for surgical planning, aids in the consideration of surgery, and helps delineate the extent of infection in methicillin-resistant Staphylococcus aureus bone and joint infections in children [54]. Patients undergoing lumbar decompressive surgery should have sagittal whole spine MRI studies pre-operatively to exclude proximal neurological compression [82].

CT: The use of postoperative routine CT for pedicle screw accuracy in thoracolumbar fractures must be discussed critically, as no consequences were drawn from routine CT in asymptomatic patients regarding screw accuracy [81].

Other Considerations: Timing of symptoms, imaging results, and the development of atypical symptoms can help distinguish Guillain-Barré Syndrome from other postoperative spinal complications [5]. Symptomatic postoperative epidural hematomas and seromas are rare but potentially grave complications requiring thorough understanding of pathophysiology, meticulous clinical evaluation, and radiographic interpretation [8]. Recognition of paradoxical cerebral embolism is important for orthopaedic surgeons and those involved with postoperative management [9]. Adverse events associated with anterior cervical spine surgery are infrequent but can be serious and potentially life-threatening [11]. Surgeons must be aware of neurovascular complications of knee arthroscopy to recognize them early and initiate prompt evaluation and treatment [12]. A thorough understanding of complications associated with anterior lumbar surgery aids in prevention, recognition, and management of these rare problems [14]. Serious neurological complications can occur with vertebroplasty unless careful attention is paid to technical details, including the use of appropriate imaging and cement consistency [24]. The diagnosis of aseptic loosening involves a careful history, focused clinical exam, and thorough evaluation of imaging using several diagnostic modalities [73]. Careful review of preoperative imaging is important for selecting patients at potential risk for further investigation before undergoing revision surgery involving internal iliac artery injury [80]. Functional and radiographic results are satisfying after a mean follow-up of 5 years for two-stage revisions with articulating antibiotic spacers after failed and infected elbow surgery, though the complication rate for this procedure is high (25%) [85]. CC fixation failure of greater than 50% of the unaffected side in radiological examinations occurred in 33% of patients within 3 months after arthroscopic coracoclavicular reconstruction using a single adjustable–loop–length suspensory fixation device [88]. Additionally, 44% of patients had complications after arthroscopic coracoclavicular reconstruction using a single adjustable–loop–length suspensory fixation device in acute acromioclavicular joint dislocation [88].

Treatment

Non-Operative

Conservative management is indicated for moderate nonprogressive Coxa Vara in childhood, which often does not require surgery [89]. Nonoperative treatment yields good functional outcomes in Neer Type II distal clavicle fractures despite a 31% nonunion rate [92]. Conservative management with observation and therapy can lead to full recovery in cases of cement extrusion causing radial nerve palsy after shoulder arthroplasty [90]. Extensive subcutaneous emphysema following arthroscopy can be managed conservatively with a full recovery [86]. Distal peripheral neuropathy after open and arthroscopic shoulder surgery will often resolve with nonoperative management [87]. Conservative management of intracardiac cement embolism following spinal vertebral augmentation should be avoided due to the potential for delayed complications [65]. There has never been a properly conducted trial of surgery versus active conservative care for acute spinal cord injury, so it is not known whether early surgery or active physiological management offers the better chance for recovery [75].

Operative

Indications: Surgical management is indicated for Coxa Vara in childhood when there is progressive, painful, unilateral deformity or leg-length discrepancy [89]. Surgical decompression is an effective treatment option for distal peripheral neuropathy after open and arthroscopic shoulder surgery in refractory cases [87]. Operative intervention for paralumbar compartment syndrome offers positive outcomes and symptom relief compared to non-operative treatment [64]. Surgical management is indicated for Coxa Vara in childhood when there is progressive, painful, unilateral deformity or leg-length discrepancy [89].

Surgical Approach / Technique: Multilevel en bloc spondylectomy for tumors of the thoracic and lumbar spine is associated with a high complication rate, though most patients recover from complications [2]. Serious neurological complications can occur with percutaneous vertebroplasty unless careful attention is paid to technical details, including the use of appropriate imaging and cement consistency [24]. Thorough knowledge of potential complications and surgical technique enhances the likelihood of optimizing outcomes in total elbow arthroplasty [21]. Complications following elbow arthroscopy cannot be eliminated but can be minimized substantially by following a systematic approach that includes correct indications, thorough preoperative preparation, availability of necessary equipment, and proper surgical technique [46]. Early complication rate should not serve as the sole impetus to direct surgical technique for open biceps tenodesis versus arthroscopic, as the number needed to treat is high [4].

Implant Selection: Surgeons should be aware of differing complications related to their implant of choice in total elbow arthroplasty, as each implant has its own specific complication profile [25]. Trauma as an indication for total elbow arthroplasty appears to have increased complication rates compared to inflammatory arthropathy [25].

Alignment / Balancing Strategy: Early postoperative outcomes and complication rates were similar between anatomic and reverse total shoulder arthroplasty in an ambulatory surgery center [38].

Pain Management: No definitive conclusions regarding mortality benefit of surgical intervention over conservative management for geriatric odontoid fractures could be determined due to interstudy heterogeneity and lack of standardized evidence [41].

Adjuncts: Drainage does not have a significant impact on reducing the incidence of postoperative complications or improving clinical efficacy in single-level lumbar discectomy [30]. The routine use of a wound drain in non-complex lumbar surgery does not prevent post-operative epidural haematomas [91]. The absence of a wound drain in non-complex lumbar surgery does not lead to a significant change in the incidence of wound infection [91]. Closed incision negative-pressure wound therapy (ciNPWT) has been shown to be clinically effective for incisions at high risk for perioperative complications [20].

Setting of Care: Optimised fast-track protocols in total knee arthroplasty determine shorter hospitalisation time and lower perioperative/postoperative complications [39].

Other Considerations: Major surgical complications occurred in 11.6% of patients treated with high-dose rhBMP-2 for adults [1]. Major medical complications occurred in 11.6% of patients treated with high-dose rhBMP-2 for adults [1]. Surgical site complications requiring readmission or reoperation should be considered major complications [3]. Increasing severity of preoperative anemia is associated with higher postoperative medical and surgical complications after primary shoulder arthroplasty [7]. Patients who received postoperative transfusions presented elevated rates of medical complications, 90-day mortality, and surgical complications [7]. Prompt management is mandatory when wound complications occur in total knee arthroplasty [10]. The incidence of 30-day postoperative adverse events following elbow arthroscopy is 1.89% [18]. The need to return to the operating room following elbow arthroscopy is 0.94% [18]. Perioperative vision loss is a rare but devastating complication with a poor prognosis and no proven effective treatment [40]. Prevention of perioperative vision loss through strategies such as avoiding direct eye pressure, optimizing hemodynamics, and minimizing surgical time is the most effective approach [40]. Open biceps tenodesis may be considered in more high-risk individuals despite a slightly greater rate of 30-day complications compared to arthroscopic techniques [4].

Complications

Wound complications: Surgical site complications requiring readmission or reoperation are classified as major complications [3]. In total joint arthroplasty, short-term 30-day surgical site infections occur in approximately 1% of patients [48]. Patients undergoing shoulder surgery with a history of cervical spine conditions exhibit increased rates of surgical complications compared to those without dual shoulder-cervical spine pathology [69]. Additionally, C. acnes infections are common following sternoclavicular joint surgery, where complications occur more frequently than previously described [74].

Infection (PJI): While rotator cuff repair has a low incidence of short-term complications [45], major surgical and medical complications occurred in 11.6% of patients receiving high-dose rhBMP-2 for adults [1]. In the context of spinal procedures, a short-term difference in costs for cauda equina syndrome was observed in the first postoperative year after spinal decompression, though this difference did not persist into the second year [27].

Thromboembolism: Patients with a history of coronary angiography, particularly those with stent placement, face higher postoperative complications in total joint arthroplasty [83]. For these patients, myocardial infarction and cerebrovascular accident risks remain elevated regardless of surgery timing in both total hip and total knee arthroplasty groups [83].

Other Considerations: Early complication rates should not dictate surgical technique for open biceps tenodesis due to a high number needed to treat, though open techniques may be considered for high-risk individuals given similar early complication rates compared to arthroscopic methods [4]. Various patient demographics, medical comorbidities, and surgical factors predict short-term complications following distal biceps tendon repair [6]. Postoperative complications after ankle fracture surgery are relatively rare but can lead to considerable morbidity [13]. Complication and revision rates for unconstrained shoulder prostheses increase substantially with longer follow-up duration [15]. The rate of surgical complications and related hospital admissions following shoulder arthroplasty in the US Medicare population remained meaningful throughout the entire year after surgery, suggesting a follow-up period longer than the traditional 90 days may be warranted [17]. The incidence of 30-day postoperative adverse events following elbow arthroscopy is 1.89%, with a 0.94% need to return to the operating room [18]. There are no differences in short-term complications, 2-year revision rates, unplanned office visits, or readmissions between outpatient and inpatient hip arthroplasty [19]. Intraoperative complications following high tibial or distal femoral osteotomy occur at a rate of 1.2%, while early (≤90 days) postoperative complications occur at a rate of 42.0% [26]. Arthroscopic elbow surgery is more challenging and may lead to higher complication rates in less experienced hands for patients with a history of trauma or previous surgery [28]. History of prior implant complication was the most important patient feature for XGBoost performance in predicting complications and unplanned readmission following primary anatomic total shoulder replacements [76]. The incidence of major postoperative complications in 80 and 81-year-old patients undergoing lumbar spine fusion surgery was 10 times higher than that of 77-year-old patients [79].

Recovery

Light activity (weeks): Evidence does not specify a precise week range for light activity or driving across the provided literature. However, early complication rates for biceps tenodesis and distal biceps repair are assessed within 30 days, and wound complications in total knee arthroplasty require early identification [4, 6, 107]. For spinal procedures, symptom timing and imaging help distinguish complications like Guillain-Barré syndrome within the immediate postoperative period [5].

Full activity (months): The evidence does not define a specific month range for full activity or return to sport. However, revision rates for unconstrained shoulder prostheses increase substantially with longer follow-up, and complication rates in shoulder arthroplasty remain meaningful throughout the entire year after surgery [15, 17]. High tibial and distal femoral osteotomies demonstrate a relatively high rate of early postoperative complications (42.0%) within 90 days [26].

Complete recovery / outcome plateau (months): A postoperative follow-up period longer than the traditional 90 days may be warranted for shoulder arthroplasty due to sustained complication rates [17]. For cervical laminoplasty compared with posterior laminectomy and fusion, there are no differences in revision rates up to 5 years of follow-up [63]. In high tibial osteotomy, patients with a preoperative symptom duration of two years or greater do not experience inferior outcomes at mid-term follow-up compared to those with shorter durations [108].

Rehabilitation protocol: The evidence does not provide specific details on physical therapy phasing, immobilisation duration, or weight-bearing progression. However, a time-dependent approach to intervention escalation is critical for wound management in total knee arthroplasty with persistent drainage [107]. For anterior cervical discectomy and fusion, patients should be managed postoperatively to mitigate long-term impairments from voice complications [66].

Functional milestones: The evidence does not cite specific PROM trajectories or benchmark scores. However, the long-term clinical success of polymethylmethacrylate-assisted ventral discectomy does not seem to be negatively affected by the procedure [62]. For unilateral laminotomy with bilateral spinal canal decompression, specific outcomes and complications require further confirmation in larger, long-term follow-up studies [56].

Other Considerations: Open biceps tenodesis is associated with a slightly greater rate of 30-day complications than arthroscopic biceps tenodesis, though the number needed to treat is high regarding early complication rates [4]. Arthroscopic biceps tenodesis may be considered in more high-risk individuals despite similar early complication rates [4]. Patient demographics, medical comorbidities, and surgical factors predict short-term complications following distal biceps tendon repair [6]. Age older than 60 years, surgical time greater than 90 minutes, chronic obstructive pulmonary disease (COPD), inpatient status, disseminated cancer, and current smoking increase the risk of complications within 30 days after arthroscopic shoulder surgery [106]. High tibial osteotomy and distal femoral osteotomy procedures have a low rate of intraoperative complications (1.2%) but a relatively high rate of early (≤90 days) postoperative complications (42.0%) [26]. Arthroscopic elbow surgery is more challenging and might lead to higher complication rates in patients with a history of trauma or previous surgery, particularly in less experienced hands [28]. There are no differences regarding postoperative short-term complications, 2-year revision rates, or unplanned office visits between outpatient and inpatient hip arthroplasty [19]. A longer time to surgery from the time of injury is associated with a worse prognosis in spinal cord injury without radiographic abnormality (SCIWORA) [60]. Patients should be counseled preoperatively about the potential risk of postoperative voice complications following anterior cervical discectomy and fusion [66]. A short-term difference in costs for cauda equina syndrome is observed in the first postoperative year after spinal decompression, but not in the second year [27]. The long-term clinical implication of culture positivity in primary total shoulder arthroplasty requires further study regarding the risk of late failures [59].

Key Evidence

• [L4] Major surgical complications occurred in 11.6% of patients, and 11.6% experienced major medical complications. (10.2106/jbjs.l.01730)
• [L4] Although the surgical procedure is challenging and associated with a high complication rate, most patients recovered from their complications, validating the technique. (10.1007/s11999-014-3578-x)
• [L3] Surgical site complications requiring readmission or reoperation should be considered major complications. (10.1016/j.arth.2007.01.007)
• [L3] Early complication rate should not serve as impetus to direct surgical technique as number needed to treat is high, although ABT may be considered in more high-risk individuals. (10.1016/j.arthro.2018.11.036)
• [L5] The timing of symptoms, imaging results, and the development of atypical symptoms can help distinguish this rare possibility from other postoperative spinal complications. (10.5435/jaaos-d-16-00572)
• [L3] Various patient demographics, medical comorbidities, and surgical factors were all predictive of short-term complications. (10.5397/cise.2021.00472)
• [L3] Patients who received postoperative transfusions presented elevated rates of medical complications, 90-day mortality, and surgical complications. (10.1016/j.jse.2023.10.005)
• [L5] Symptomatic postoperative epidural hematomas and postoperative seromas are rare but potentially grave complications requiring thorough understanding of pathophysiology, meticulous clinical evaluation, and radiographic interpretation for appropriate management and optimal outcomes. (10.5435/jaaos-d-22-01022)
• [L4] Recognition of this rare complication is important for orthopaedic surgeons and those involved with postoperative management. (10.2106/00004623-199901000-00014)
• [L5] When wound complications occur, prompt management is mandatory. (10.1007/s00167-010-1328-5)
• [L4] Adverse events associated with anterior cervical spine surgery are infrequent but can be serious and potentially life-threatening; appropriate strategies must be utilized to avoid these events, and surgeons must understand how to detect and manage them when they arise. (10.5435/00124635-200812000-00005)
• [L4] Surgeons must be aware of these complications to recognize them early and initiate prompt evaluation and treatment. (10.1177/03635465020300042501)
• [L3] Although postoperative complications are relatively rare, their treatment can lead to considerable morbidity. (10.2106/jbjs.23.00745)
• [L4] A thorough understanding of the complications associated with anterior lumbar surgery will aid in prevention, recognition, and management of these rare problems. (10.5435/00124635-201105000-00002)
• [L2] Complication and revision rates increase substantially with longer follow-up duration. (10.1016/j.jse.2010.11.017)
• [L4] The radiology reports of routine immediate postoperative radiographs rarely identified postoperative complications (0.2%). (10.1016/j.jse.2022.10.027)
• [L3] The finding that the rate of surgical complications and related hospital admissions remained meaningful during the entire year after surgery suggests that a postoperative follow-up period longer than the traditional 90 days may be warranted. (10.1016/j.jses.2017.10.002)
• [L4] Overall, the incidence of 30-day postoperative adverse events (1.89%) and need to return to the OR (0.94%) is low. (10.1016/j.arthro.2017.08.286)
• [L3] We found no differences regarding postoperative short-term complications or 2-year revision rates, and no differences in unplanned office visits or readmissions. (10.1186/s13018-020-01871-8)
• [L4] ciNPWT has been shown to be clinically effective for incisions at high risk for perioperative complications, although specific indications continue to be defined. (10.5435/jaaos-d-17-00054)
• [L4] Thorough knowledge of potential complications and surgical technique enhances the likelihood of optimizing outcomes. (10.5435/00124635-201106000-00003)
• [L4] Higher complication rates are observed after more complex surgery. (10.1016/j.arthro.2023.04.015)
• [Letter] The authors agree that more standardized reporting of complication rates and categories would be beneficial, but note that their systematic review was limited to capturing only complications reported as such by the individual authors of the included manuscripts. (10.1016/j.jse.2022.04.012)
• [L5] The case demonstrates that serious neurological complications can occur with vertebroplasty unless careful attention is paid to technical details, including the use of appropriate imaging and cement consistency. (10.2106/00004623-200107000-00014)
• [L2] Surgeons should be aware of differing complications related to their implant of choice, each having its own specific complication, and trauma as an indication appears to have increased complication rates compared to inflammatory arthropathy. (10.1177/1758573220905629)
• [L4] These 15-year data revealed a low rate of intraoperative complications (1.2%) and a relatively high rate of early (≤90 days) postoperative complications (42.0%) after an HTO or DFO procedure. (10.1177/03635465231183092)
• [L3] A short-term difference in costs was observed in the first postoperative year, but not in the second year. (10.5435/jaaos-d-23-01215)
• [L4] However, in patients with a history of trauma or previous surgery, the procedure is more challenging and might lead to higher complication rates in less experienced hands. (10.1016/j.jse.2013.01.032)
• [L5] A systematic approach to treatment is required for the adult patient presenting with late or chronic complications after spinal surgery, involving patient assessment, differential diagnosis formulation, and familiarity with different surgical approaches. (10.5435/jaaos-d-16-00530)
• [L1] However, drainage does not have a significant impact on reducing the incidence of postoperative complications or improving clinical efficacy. (10.1186/s12891-020-03504-x)
• [Case_report] The authors hope reporting this complication will inform surgeons as to its potential, outline preventative measures, and provide guidance for management should it arise postoperatively. (10.1016/j.xrrt.2023.04.005)
• [Abstract] The majority of complications are minor and likely do not affect the clinical outcome. (10.1016/j.jse.2012.12.047)
• [L4] Early diagnosis and emergent surgical intervention promote better outcomes. (10.1186/s12891-021-04443-x)
• [L3] This rate of complications is in line with complication rates after open surgical dislocation using the same classification system. (10.1016/j.arthro.2013.09.046)
• [L3] The clinical classification systems established herein facilitate precise risk stratification, enabling targeted preoperative interventions to mitigate surgical risks and enhance surgical outcomes. (10.1186/s13018-025-06112-4)
• [L4] Prompt diagnosis and repair prevents limb-threatening complications. (10.1007/s001670050011)
• [L4] Recognition by the orthopaedic surgeon of the presenting features of acute colonic pseudo-obstruction is important to facilitate prompt initiation of treatment, which may hasten recovery and reduce the morbidity and mortality associated with this complication. (10.2106/00004623-199711000-00005)
• [L3] Early postoperative outcomes and complication rates were similar between the 2 groups, and all patients were successfully discharged home the day of surgery. (10.1016/j.jse.2022.05.010)
• [L3] The best-track protocol has demonstrated its efficacy in reducing hospitalisation time and perioperative/postoperative complications. (10.1002/ksa.12122)
• [L4] Perioperative vision loss is a rare but devastating complication with a poor prognosis and no proven effective treatment; therefore, prevention through strategies such as avoiding direct eye pressure, optimizing hemodynamics, and minimizing surgical time is the most effective approach. (10.5435/jaaos-d-15-00351)
• [L1] Despite high morbidity and mortality, no definitive conclusions regarding mortality benefit of surgical intervention over conservative management could be determined due to interstudy heterogeneity and lack of standardized evidence. (10.5435/jaaos-d-23-00389)
• [L4] The biomechanics of the lumbar spine may differ with each individual, and L4–5 dislocation may be a variant to lumbosacral (L5-S1) dislocation, owing to hyperextension injury. (10.1186/s12891-019-2921-5)
• [L3] While the risk of complications remains relatively low, surgeons should be aware of these increased risks when selecting surgical techniques. (10.1016/j.jseint.2022.01.001)
• [L4] The complication rates between the two surgical procedures were similar. (10.1186/s12891-024-07353-w)
• [L4] Rotator cuff repair has a low incidence of short-term complications. (10.1016/j.arthro.2017.10.040)
• [L4] Complications following elbow arthroscopy cannot be eliminated, but they can be minimized substantially by following a systematic approach to the procedure that includes use of the procedure for the correct indications, thorough preoperative preparation, the availability of all necessary equipment, and use of the proper surgical technique. (10.2106/jbjs.j.01272)
• [L1] Thirty-seven percent of adverse events were reclassified by the CEC; the large majority of the reclassifications were an upgrade in the level of severity or a designation of greater relatedness to the surgery or device. (10.2106/jbjs.l.00251)
• [L2] Scientific literature on surgically-managed PHF uses different terms to describe complications and without approved definitions, which highlights a lack of agreement on adverse event terminology for PHFs. (10.1186/s12891-020-03353-8)
• [L3] Both the Clavien-Dindo classification and Comprehensive Complication Index appear valid and applicable to patients undergoing total joint replacement. (10.1302/0301-620x.107b1.bjj-2023-1400.r2)
• [L2] This point-scoring system predicts risk for general postoperative complications after hand surgery. (10.1016/j.jhsa.2018.05.001)
• [L3] Patients classified as ASA class III or IV were identified to be at a significantly increased risk of complications following elective hand surgery. (10.1177/1558944720944260)
• [L4] Although the current evidence is of poor quality, it suggests that some types of hand surgery may be done outside the operating theatre without increasing the risk of infection. (10.1177/1753193416676408)
• [L5] Early use of MRI helps delineate the extent of infection, aids in the consideration of surgery, and provides valuable information for surgical planning. (10.5435/jaaos-23-01-29)
• [L3] They also do not adversely affect radiographic outcomes postoperatively. (10.1016/j.arth.2024.08.006)
• [L4] This, however, needs to be further confirmed in larger, long-term follow-up, prospective, comparative studies between open, and minimally invasive techniques. (10.1186/s12891-023-07033-1)
• [L4] The current classification has only moderate reliability, suggesting that an alternative classification method is needed. (10.1016/j.jse.2013.02.007)
• [L3] The occurrence of postoperative complications is multifactorial and related to operation time, ASA class, insulin-dependent diabetes, and steroid use for chronic condition. (10.1186/1749-799x-9-15)
• [L3] The long-term clinical implication of this finding requires further study, especially with regard to the risk of late failures of shoulder arthroplasty. (10.1016/j.jse.2018.05.024)
• [L4] Longer the time to surgery from the time of injury, the worse was the prognosis. (10.1186/s13018-020-01743-1)
• [L4] However, the findings are limited by unblinded surgeon review of radiographs and unknown patient selection criteria. (10.1007/s00167-003-0485-1)
• [L3] But the clinical long-term success does not seem to be negatively affected by this. (10.1186/1471-2474-12-140)
• [L3] Up to 5 years of follow-up, there were no differences in revision rates for LP compared with LF; however, LP was associated with fewer postoperative complications than LF. (10.5435/jaaos-d-22-00106)
• [Case_report] Operative intervention offers positive outcomes and symptom relief compared to non-operative treatment. (10.1186/s13018-024-04860-3)
• [L4] However, due to the potential for delayed complications, conservative management should be avoided. (10.1186/s13018-025-06380-0)
• [L2] Patients should be counseled preoperatively about the potential risk, and managed postoperatively to mitigate long-term impairments. (10.1186/s13018-025-05464-1)
• [L4] However, many patients have radiolucencies, and the discrepancy between clinical signs and radiological results warrants structural follow-up. (10.1186/s12891-019-2781-z)
• [L5] Less facetectomy is better because it may reduce the risk of biomechanical deterioration and consequently, that of FBSS. (10.1186/s12891-019-2751-5)
• [L2] Patients undergoing shoulder surgery with a history of a cervical spine condition have increased rates of surgical complications and mixed but consistently nonsuperior patient-reported outcomes compared to patients without dual shoulder-cervical spine pathology. (10.1016/j.arthro.2025.01.010)
• [L3] Routine early postoperative radiographs after implant removal are overutilized and do not provide clinical benefit for most pediatric patients, as they rarely change postoperative management. (10.5435/jaaos-d-22-00883)
• [L3] However, the incidence of major complications is much higher than with other types of total knee arthroplasty and arthrodesis, so this type of arthroplasty should be reserved for specific clinical situations. (10.2106/00004623-198062040-00004)
• [L5] The study concluded the biomechanical effects still afford nearly sufficient spine support and gentle adjacent segment stress after rod fracture in a worst-case scenario of the thinnest PS of the SHE rod system. (10.1186/s12891-022-05768-x)
• [L5] The diagnosis of aseptic loosening involves a careful history, focused clinical exam, and thorough evaluation of imaging using several diagnostic modalities, with careful evaluation of serial radiographs remaining the cornerstone of diagnosis. (10.1016/j.arth.2022.02.060)
• [L4] Complications after SCJ surgery occur more often than previously described, with C. acnes infections being common. (10.1016/j.jse.2020.09.015)
• [L5] There has never been a properly conducted trial of surgery versus active conservative care, so it is still not known whether early surgery or active physiological management offers the better chance for recovery. (10.1302/0301-620x.105b4.bjj-2023-0111)
• [L3] History of prior implant complication was the most important patient feature for XGBoost performance, a novel patient feature that surgeons should consider when counseling patients. (10.1177/24715492221075444)
• [L5] Orthopaedic surgeons should be aware of pathophysiology and related risks associated with spine surgery in the prone position, and initiate preventive measures and predictable treatment options. (10.5435/00124635-200703000-00005)
• [L3] Routine PACU radiographs, in the absence of a specific indication, may result in poor-quality images. (10.1007/s11999-012-2551-9)
• [L3] The incidence of major postoperative complications in 80 and 81-year-old patients was 10 times higher than that of 77-year-old patients. (10.1186/s12891-023-06689-z)
• [L5] This previously unreported delayed presentation of a vascular injury highlights the importance of careful review of preoperative imaging and selecting those that are at potential risk for further investigation before undergoing revision surgery. (10.1016/j.arth.2012.02.027)
• [L3] No consequences were drawn from postoperative routine CT in asymptomatic patients, therefore its use has to be discussed critically. (10.1186/s12891-021-04860-y)
• [L4] The authors advise that patients undergoing lumbar decompressive surgery should have sagittal whole spine MRI studies pre-operatively to exclude proximal neurological compression. (10.1302/0301-620x.95b10.31222)
• [L3] A history of coronary angiography, especially with stent placement, is linked to higher postoperative complications, with myocardial infarction and cerebrovascular accident risks remaining elevated regardless of surgery timing in both THA and TKA groups. (10.1016/j.arth.2025.07.002)
• [L5] Further biomechanical tests and clinical studies have to proof Tektona®'s capabilities. (10.1186/s12891-020-03899-7)
• [L3] Functional and radiographic results are satisfying after a mean FU of 5 years, although the complication rate is high (25%). (10.1016/j.jse.2021.03.125)
• [Case_report] It can be managed conservatively with a full recovery. (10.1007/s00167-001-0264-9)
• [L4] When it occurs, DPN will often resolve with nonoperative management, and surgical decompression is an effective treatment option in refractory cases. (10.1016/j.jse.2014.08.007)
• [L4] However, CC fixation failure of greater than 50% of the unaffected side in radiological examinations occurred in 33% of the patients within 3 months after the operation, and 44% of patients had complications. (10.1016/j.arthro.2014.11.013)
• [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
• [Case_report] Conservative management with observation and therapy can lead to full recovery. (10.1016/j.jse.2009.01.006)
• [L1] The routine use of a wound drain in non-complex lumbar surgery does not prevent post-operative epidural haematomas, and the absence of a drain does not lead to a significant change in the incidence of wound infection. (10.1302/0301-620x.98b7.37190)
• [L1] Nonoperatively treated patients showed good functional outcome despite the 31% nonunion rate. (10.1177/03635465211053336)
• [L3] Compared to traditional decompression combined with rigid fusion surgery, decompression coupled with dynamic stabilization techniques can more effectively alleviate postoperative lumbar stiffness and functional impairment in patients. (10.1186/s13018-025-05837-6)
• [L3] Traumatic intervertebral disc injury contributes to loss of correction following thoracolumbar fractures and is closely associated with accelerated disc degeneration. (10.1186/s12891-025-08759-w)
• [L3] Patients with multilevel fusions had more abnormal spinal sagittal balance and a higher risk of dislocation despite higher baseline and postoperative acetabular anteversion. (10.5435/jaaos-d-24-00606)
• [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. (10.1016/j.jse.2024.12.023)
• [L3] Conversely, a larger preoperative cervical curvature and early postoperative functional exercises can help reduce the occurrence of axial symptoms. (10.1186/s13018-023-04426-9)
• [L3] Short-segment fixation across the injured vertebra (6s) provides results comparable to short-segment fixation (4s) while causing less trauma. (10.1186/s13018-025-05509-5)
• [L3] The study developed a personalized risk calculator to assess the risk of proximal junctional kyphosis after adult spinal deformity surgery based on novel and modifiable clinical features, facilitating individualized risk factor assessment and guiding perioperative management. (10.1302/0301-620x.107b8.bjj-2024-1474.r2)
• [L4] Robotic-assisted spine surgery holds enormous future potential, but its broader adoption may benefit from a comprehensive understanding of challenges such as registration errors, trajectory inaccuracies, and technical failures. (10.5435/jaaos-d-25-00031)
• [L4] A facet angle greater than 45 degrees at the L4-5 level and larger amounts of fluid in the facet joints are associated with failure of primary decompression. (10.5435/jaaos-d-21-00258)
• [L3] Posterior superior iliac spine height has a large impact on PS placement in the lower lumbar spine. (10.1186/s12891-024-07919-8)
• [L3] In patients undergoing long fusion to the sacrum, realignment based on these targets may lead to fewer mechanical failures. (10.2106/jbjs.23.00372)
• [L4] Age older than 60 years, surgical time greater than 90 minutes, COPD, inpatient status, disseminated cancer, and current smoking all increased a patient's risk of complications. (10.1016/j.arthro.2014.12.011)
• [L2] The time-dependent approach to intervention escalation provides clear clinical decision-making criteria and suggests that early identification and systematic management of wound complications are critical determinants of successful outcomes. (10.1002/ksa.70077)
• [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)

See Also

• Disc Degeneration
• Pain Management

References

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