bluuebunny/crossref_metadata_2025 huggingface dataset:
Orthopaedic Resident Preparation and Confidence in Treating On-Field Injuries
Authors: Hodax Jonathan D. , Sobel Andrew D. , DeFroda Steven , Chambers Alison B. , Hulstyn Michael J.
Published: May 2017

Background:

Orthopaedic surgery residents may cover athletic events, although the training provided to prepare residents for this role and oversight from attending physicians during these activities is not well understood.

Purpose:

To survey orthopaedic residents about the training provided by their residency program for on-field athletic coverage and to understand their levels of preparation for this role and confidence in treating commonly encountered on-field conditions.

Study Design:

Descriptive epidemiology study.

Methods:

An anonymous survey was emailed to residents in all American College of Graduate Medical Education–accredited, allopathic, nonmilitary orthopaedic surgery residency programs. This survey queried residents about their demographics, the opportunities their residencies require or allow for athletic coverage, their level of preparation for serving an on-field physician, and their comfort level with treating a number of on-field conditions. Likert-type scales were used to assess resident comfort level for treating 13 orthopaedic and nonorthopaedic conditions as well as their perceived level of preparedness.

Results:

Of 148 residency programs contacted, 57 programs responded (39%). Of the 57 programs responding, 51 (89.5%) allowed or required residents to cover athletic events, and 27 of 51 (52.9%) reported that training to prepare for this role was provided. Only 6 of 24 programs without training available (25%) had direct attending supervision of residents at all athletic events. Residents who answered that their residency programs mandate training prior to their participation in athletic coverage activities reported a higher level of preparation for this role than those with no training, optional training, or those who were unsure of their training requirement ( P < .0001, P = .035, and P = .013, respectively). In addition, the more senior the resident was, the higher the level of confidence was in treating all orthopaedic and some nonorthopaedic conditions. Residents who had mandatory training displayed a higher comfort level in treating on-field orthopaedic and nonorthopaedic conditions than those without training.

Conclusion:

Formal training of orthopaedic residents prior to their covering athletic events can improve confidence in treating orthopaedic and nonorthopaedic conditions. Many programs do not ensure that residents are familiar with key and potentially life-saving equipment. An opportunity exists to improve resident education.
Early Results & Accuracy of the MAKO Robtic Unicompartmental Knee Replacement
Authors: GANKO Anthony , DONNELLY William , BRENNAN Stephen , ENGLISH Hugh , HALLIDAY Brett , CRAWFORD Ross
Published: May 2017

Objectives:

To monitor the “learning curve” and assess the accuracy of implantation, safety and early results of a new to Australia, technique for unicompartmental knee replacement

Methods:

After cadaveric training, the first 50 MAKO unicompartmental replacements, performed by 5 surgeons, were studied. Operative details were recorded including time taken for each step in the surgical procedure. Pre and post operative Knee Society Score (KSS), Oxford knee score (OKS) and WOMAC were recorded. 19 had post-operative CT scans with segmentation using planning software to determine accuracy of implantation compared to plan.

Results:

In the small number studied there was no evidence of a significant “learning curve” with no significant change in operative times. The procedure proved safe without any failure of technology. At 3 months there was a significant improvement in KSS, WOMAC and OKS. The unicompartmental replacements were inserted with a high degree of accuracy, comparable to other centres and with greater accuracy then reported implantation using “standard” instruments.

Conclusion:

New robotic technology was able to be introduced safely without a significant learning curve and with satisfactory early results. The technique allowed highly accurate component positioning.
Does Image Derived Instrumentation Alter Revision Rates? An AOANJRR Analysis
Authors: McAuliffe MJ , Beer B , Hatch J , Whitehouse SL , Crawford RW
Published: May 2017

Objectives:

Image Derived Instrumentation (IDI) has been introduced into regular use in modern day total knee arthroplasty (TKA) with many potential benefits touted. Despite this, much of the research involving IDI has failed to prove any significant benefit in alignment, operative time, blood loss and cost. The purpose of this study, the first of its kind, was to compare IDI with non-IDI TKA with respect to rate of revision.

Methods:

The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) was queried to analyse the survivorship of primary TKAs using IDI reported to the AOANJRR, between April 2009 to December 2014, compared with those without IDI instrumentation. Subgroup analysis was performed to determine the effect of polyethylene insert thickness upon IDI outcomes. The Kaplan-Meier method and proportional hazards models were used to determine the cumulative rates of revision and which prostheses or circumstances lead to an increased risk of revision.

Results:

In the period studied, there were 11197 primary TKAs performed utilising IDI. This was 4.8% of all primary TKAs during this period. The overall rate of revision/100 observed years was 1.07 in the PSI group, compared with, 0.82 in the standard group. This was equivalent to a hazard ratio (HR) of 1.15 (1.01,1.31; p=0.041). Posterior stabilised (PS) knees in particular showed an increased risk when compared with minimally stabilised knees when using IDI (HR=1.49; p=0.002) and non-IDI PS knees (HR=1.30; p=0.014). Subgroup analysis of the PSI (Zimmer); Signature (Vanguard) and Visionaire (Smith and Nephew) systems by polyethylene insert thickness found varied alteration in revision rates. Of the specific prosthetic combinations examined the NEXGEN CR FLEX/NEXGEN >11 mm poly (909 pts) HR 1.83 p=0.022 and GII Oxinium PS/GII <11 mm poly (868 pts) HR 1.45 p=0.049 were found to have significantly elevated risk of revision with the use of IDI.

Conclusion:

Using the AOANJRR we have shown that in primary TKAs, the use of IDI is associated with an increased overall revision rate. This is particularly prevalent in those knees using posterior stabilisation. The effect of polyethylene insert thickness varied dependent on manufacturer. The reasons for this cannot be determined from this analysis but suggest caution should be exercised in relation to this technology. Further study is warranted to better understand the reasons for increased revision rates.
Outcomes of Constrained Prostheses in Primary and Revision TKR
Authors: Parkinson Ben , Lorimer Michelle , Lewis Peter
Published: May 2017

Introduction:

The decision to use varus/valgus constrained or hinge knee prostheses in complex Total Knee Replacement (TKR) cases is difficult. There are few publications that compare survival rates, to aid this decision-making. This study compares the survival rates of unlinked fully constrained and hinge constrained prostheses in the primary and revision settings.

Methods:

Data from the AOANJRR to 31st of December 2013 was analysed to determine the survival rate of unlinked and hinge constrained TKR in the primary and revision settings (excluding the diagnosis of tumour and infection). Only first-time revisions of a known primary TKR were included in the revision analysis. Kaplan-Meier estimates of survivorship were calculated for the two categories of constraint and were matched for age and diagnosis in both primary and revision TKR situations. Hazard ratios using the Cox proportional-hazards model were used. The survivorship of individual prosthesis models was determined.

Results:

There were 3237 prostheses implanted during the study period that met the inclusion criteria. Of these, 1896 were for primary TKR and 1341 for revision TKR. There were 1349 unlinked fully constrained and 547 hinge prostheses for primary TKR and 991 unlinked fully constrained and 350 hinge prostheses for revision TKR. In both the primary and revision settings when matched by age, there was no difference in rates of revision for either level of constraint. When matched by indication in the primary setting, there was no difference in the rates of revision for either level of constraint. The rate of revision for both categories of constrained prosthesis was significantly higher in younger patients <55 years of age (p < 0.05). There were no differences in survival rates of individual models of constrained TKR.

Conclusions:

The survival rates of unlinked constrained and hinge knee prostheses are similar when matched by age or diagnosis. In complex TKR instability cases, surgeons should feel confident in choosing the appropriate prosthesis to gain a stable knee and need not be concerned that a hinge prosthesis may carry a higher revision rate.
The Effect on Long Term Survivorship of Surgeon Preference for Posterior Stabilized or Minimally Stabilized Total Knee Replacement: An Analysis of 63416 Cases from the AOANJRR
Authors: Vertullo Christopher , Lewis Peter , Lorimer Michelle , Graves Stephen
Published: May 2017

Introduction & Aims:

Controversy still exists as to the optimum management of the PCL in TKR, with registry data suggesting Posterior Stabilised TKR have a higher Cumulative Percent Revision (CPR) compared to Minimally Stabilised TKR. Proponents of PS TKR suggest this difference is due to selection bias as result of preferential use of PS TKR in complex or more severe cases. To remove this selection bias, we aimed to compare CPR based on surgeon TKR stability preference to treat with PS or MS TKR rather than actual prosthesis type received.

Method:

Observational series. An analysis of AOANJRR data from 1999 – 2014 was utilized to identify two cohorts of high volume surgeons who preferred to use routinely either MS or PS TKR. Only fixed tibial inserts and patellar resurfacing TKR were included. A MS preferring surgeon used MS TKR at least 90% of the time and a PS preferring surgeon used PS TKR at least 90% of the time. Consequently, each patient cohort included both PS and MS TKR in differing proportions.

Results:

Procedures undertaken by PS preferring surgeons had a significantly higher risk of revision (CPR (Hazard Ratio = 1.45 (95% CI 1.30, 1.63), p< 0.001). There was a higher rate of revision for loosening and infection in the PS group. Of the 39 941 TKR with cemented fixation of both femur and tibia, the PS preferring surgeons had a higher CPR than the MS preferring cohort (HR = 1.55 (1.33, 1.80), p< 0.001). Regardless of whether the polyethylene was crosslinked or non-crosslinked, the MS preferring surgeons had a lower CPR compared to the PS preferring surgeons.

Conclusions:

In this analysis, procedures undertaken by surgeons who mainly preferred to use PS TKR had a higher rate of revision than those that mainly used MS TKR. This finding was irrespective of patient age and was also evident when fixation and the type of polyethylene used was taken into account.
One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome
Authors: Kejriwal Ritwik , Buelow Jens
Published: May 2017

Objectives:

Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option.

Methods:

Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases.

Results:

66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up.

Conclusion:

Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.
Variable outcomes of medial meniscectomy in middle aged and older patients after 2 to 8 years
Authors: Paterson Roger , Balasubramaniam Pradeep
Published: May 2017

Objectives:

To review midterm results of arthroscopic medial meniscectomy in patients over the age of 40.

Methods: Retrospective observational series.

All 354 patients over 40 years of age (after exclusion criteria) who underwent medial meniscectomy by a single surgeon for clinical and MRI correlated medial meniscal tears, having failed conservative treatment, between 2009 and 2014 were sent a questionnaire. Completed questionnaires from 179 patients at an average follow up of 52 ± 15 months (range, 20-79) were analysed.

Results:

The average time to maximum recovery was longer than expected at 5.6 ± 6 months (range 0.5-36). 74% (133) felt they were largely or completely relieved of symptoms, but, as predicted from past experience, 5% (8) were worse post-operatively. Symptoms became worse in the follow-up period in another 26% (47). 11% (20) had further surgery (15 to TKR). 9% (17) preferred to have left the knee alone in retrospect. Final WOMET and Tegner-Lysholm scores showed overall fair results (36% excellent, 17% good, 22% fair, 25% poor.)

Conclusion:

Medial meniscectomy in the middle aged and elderly remains controversial, with some claiming that it is no better than placebo, and possibly harmful. This data should provide guidance in counselling patients regarding the risks, and likelihood of benefit, from such surgery, and has led to the authors using more rigorous selection criteria. Prospective studies are needed.
A Prospective Outcome, MRI and Biospy Study of MACI Cartilage Transplantation
Authors: Clatworthy Mark
Published: May 2017

Objectives:

MACI has been performed by one surgeon. in New Zealand in patients who have failed a microfracture procedure A prospective study with outcome scores, serial MRI’s and biopsies has been performed

Method:

Fifteen patients have had a MACI since July 2004. All patients have a five year follow up, four a ten year follow up. No patients have been lost to follow up. The mean age is 34 (range 25-45). The mean defect size is 3.76 cm2 (range 2.2 – 6.0 cm2). VAS pain, KOOS score, IKDC subjective score, WOMAC score, SF 36 & Tegner Activity score were collected by a research assistant preoperatively and at 6 months, 1, 2, 3 5 and 10 years. An MRI scan was performed at all time intervals. Biopsies were taken at 3 – 5 years in all patients.

Results:

All outcome scores and VAS pain scores show a significant improvement post MACI up to two years, a plateau to five years the deteroriation at ten years. There are two failure to date thus survival is 87% at a mean of 8 years. MRI showed restoration of repair tissue with a mean fill of 90% at 2years, 72% at 5 years and 49% at ten years and all patients at ten years had a full thickness defect 86% of patients had bone oedema at 5 years, 100% at 10 years 28% had bone cysts at 5 years, 100% at 10 years All patients have had MACI biopsies. Eleven biopsies show fibrocartilage and four show hyaline like cartilage. Eleven have a normal ICRS arthroscopic score, three a nearly normal score and one abnormal score however 80% have a softer MACI graft than surrounding articular cartilage.

Conclusion:

Outcome scores are reasonable but are deterioating at 10 years Serial MRI’s show significant graft deterioration, increasing bone oedema and bone cyst formation At rearthroscopy 80% of grafts are soft and 73% of biopsies show fibrocartilage. MACI post microfracture is not the long term solution for isolated chondral defects.
Treatment of Symptomatic Bipartite Patella by Fragment Excision, Capsular Repair and Novel ITB Release
Authors: Caldwell Bruce , O’Reilly-Harbridge Sarah
Published: May 2017

Objectives:

The aim of this paper is to present the mid-term results of a novel technique used to treat symptomatic bipartite patella.

Methods:

Diagnosis of symptomatic bipartite patella was made by history, examination, Xray, MRI and/or bone scan. Patients with typical localised pain, pain on manually stressing the fragment, a positive ITB tightness test, a typical Xray and either, a hot bone scan or bone oedema on MRI were considered for treatment. All patients had a pre-op Kujala and Lysholm score recorded.

Surgical Technique:

Under GA and tourniquet a 4 part procedure was performed: Routine arthroscopy to assess patella tracking and fragment stability A 2 cm incision was made on the distal thigh 10-12 cm above the joint line over the ITB. A zig-zag incision was made across the ITB/IPB from anteriorly to the corner of the intermuscular septum. A 4 cm incision was made over the edge of the lateral patella. A longitudinal capsular incision was made at the edge of the patella. The capsule was reflected off the dorsal patella by sharp dissection and the bipartite fragment was excised through the synchondrosis. A watertight repair of the lateral capsule was performed with absorbable suture. Routine closures were performed.

Comment:

The author considers the ITB/IPB to be an important factor in the development and progression of the disorder. The addition of the novel release allows a tension-free capsular repair, reducing lateral facet loads, improving patella tracking without affecting patella stability

Results:

Over an 11 year period twenty patients underwent the procedure. 15 were available with a minimum 2 year and mean 6.35 year follow-up. Pre-op and post-op Kujala and Lysholm scores were compared. Patients were predominantly male (14:1) between ages 10-54 years. A clear history of trauma was present in 6 patients while in 9 symptoms were related to overuse. The pre-op Kujala score ranged from 28-90 with an average of 59. Post-op scores improved markedly with range 70-100 with 12 patients (80%) scoring >90 and an average improvement of 32 pts. Lysholm scores similarly improved significantly, with an average 32 pts improvement (range 1-66). Complications were minimal.

Conclusion:

Fragment excision, capsular repair and novel ITB release resulted in significant reproducible improvements in both objective and subjective outcome measures. Resolution of symptoms occurred in all patients suggesting the technique is a useful option in the treatment of symptomatic bipartite patella.
Risk of tibial fracture after patella distallization and strategies for prevention
Authors: Paterson Roger
Published: May 2017

Objectives:

To identify the risk of spontaneous proximal tibial shaft fracture after distallization of the patella, and prevention strategies.

Methods: Case reports and operative technique.

Two cases of tibial fracture are presented, arising from a stress riser in the tibial crest due to a residual anterior cortical defect. There had been no warning symptoms before the fractures.

Results:

The fractures required internal fixation of the proximal tibial shaft.

Discussion:

Prevention requires check X-Ray prior to return to full activity after patella distallization, and possible further surgery if a residual cortical defect is identified. At the time of the index surgery, the risk of a residual cortical defect can be minimized by ensuring accurate apposition of the two anterior bone fragments, and applying compression across the site of an oblique osteotomy between those fragments where a bone segment is resected.

Conclusion:

Awareness of this potential complication should ensure effective preventative strategies.
Meniscal Allograft Transplantation: Factors Predicting Failure
Authors: Parkinson Ben , Smith Nicholas , Thompson Peter , Spalding Tim
Published: May 2017

Background:

Meniscal allograft transplantation (MAT) has been shown to provide a significant improvement in patient reported outcomes for individuals with post-menisectomy syndrome. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery and it is difficult to ascertain which factors influence the outcome.

Hypothesis / Purpose:

The aim of this study was to determine the predictors of meniscal allograft transplantation failure in a large series in order to refine the indications for surgery and better inform future patients.

Study Design:

Prospective case series.

Methods:

All patients undergoing MAT at a single institution between May 2005 and May 2014, with a minimum of one year follow up were prospectively evaluated and included in this study. Failure was defined as removal of the allograft, revision transplantation or conversion to a joint replacement. Patients were grouped according to the articular cartilage status at the time of surgery; Group 1 – intact or partial thickness chondral loss; Group 2 - full thickness chondral loss one condyle; Group 3 - full thickness chondral loss both condyles. The Cox proportional hazards model was used to determine significant predictors of failure (cartilage grade at the time of MAT, IKDC score, lateral or medial allografts, gender, additional procedures and tissue bank source), independently of other factors. Kaplan-Meier survival curves were produced for overall survival and significant predictors of failure in the Cox proportional hazards model.

Results:

There were 125 consecutive MATs performed, with one patient lost to follow up. The median follow up was 3 years (range 1 – 10 years). The 5 year graft survival for the entire cohort was 82% (97% group 1, 82% group 2, 62% group 3). The probability of failure in group 1 was 85% lower (95% confidence interval 13 – 97%) than in group 3 at any time. The probability of failure with lateral allografts was 76% lower (95% confidence interval 16 – 89%) than medial allografts at any time.

Conclusion:

This study showed that the presence of severe cartilage damage at the time of MAT and medial allografts were significantly predictive of failure. Surgeons and patients can use this information when considering the risks and benefits of surgery.
Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur
Authors: Reid MJ , Thompson SM , Dawahn R , Jones M , Williams A
Published: May 2017

Objectives:

Cricket is one of the world’s most popular team sports. In the past it was described as a sport of moderate risk for injury however at elite level, the international cricket timetable has massively expanded to encompass several new formats leaving very little time for recuperation. We report on a series of seven elite level fast bowlers that presented with a similar injury pattern to the antero-medial femoral condyle of the knee in the leading leg. We describe the presentation, investigation and treatment of this lesion and discuss the possible aetiology. This injury pattern has not previously been reported in the literature.

Methods:

7 international level fast bowlers (two Indian and 5 English) presented to our clinic with knee pain in the lead leg (the right knee for left hand bowlers and the left knee for right handed). The mean age of the patients was 27 (20-32) and the mean duration of symptoms was 9 months (2 weeks to 2 years). In all patients a careful history and examination was undertaken followed by appropriate investigations. The main complaint was that of anterior knee pain which was restricting them from bowling. It was associated with a minor fixed flexion in three of the patients and all patients had an effusion at the time of presentation. There were no other symptoms. All patients underwent an MRI scan. A classical appearance of oedema within the medial femoral condyle (Figure 1) was noted. In 4 patients there was ascociated cartilage loss. The injury was also identified on SPECT scan (Figure 2) 3 patients were managed nonoperatively but due to more significant MRI and clinical findings Four went on to require arthroscopic surgery (Figure 3) in the form of microfracture of the lesion.

Results:

All patients returned to International cricket with a mean of 6 months in the non-operative group and 8 months in the operative group.

Conclusion:

Anterior impingement from the antero-medial tibia and femur can be a potentially career ending lesion in the fastbowler. A strong index of suspicion has to be exercised when a bowler attends with an effusion associated with episodic pain and localisation (which may be difficult to ascertain). This lesion may be present in the asymptomatic bowler, presenting with an associated injury in the same knee. This lesion is typical in this elite group and as such training schedules and medical staff need to be aware of it as a cause of significant injury.
Total Knee Arthroplasty in the 21st century: Why Do They Fail? A Fifteen-Year Analysis of 11, 135 Knees
Authors: Young Simon W , Koh Chuan Kong , Ravi Saiprasad , Zhu Mark , Vince Kelly G
Published: May 2017

Introduction and Aims:

As national total knee arthroplasty (TKA) registries evolve, there is an increasing trend towards publication of hospital and surgeon-level outcome data, with the goal of stimulating efforts to optimise the results of TKA. Such efforts first require understanding of the current mechanisms of TKA failure. Previous reports on revision TKA from tertiary referral centres lack data on the overall denominator, thus the relative importance of each failure mechanism leading to TKA revision over long term follow up remains unclear. The aim of this study was to analyse reasons for revision following primary TKA, and assess their relative frequencies over long-term follow-up.

Methodology:

11,134 primary TKA performed between 2000-2015 at one of three tertiary referral hospitals were identified. ‘Failure’ was defined as patients undergoing subsequent revision surgery involving change of of one or more components or reoperation for deep periprosthetic joint infection (PJI). Patients were identified from a combination of the New Zealand National Joint Registry and individual search of patient records and clinical coding (ICD-9 and ICD-10). All relevant clinical records, radiographs, and lab results were obtained from all New Zealand hospitals to identify the primary reason for revision according to a standardised protocol.

Results:

A total of 357 (3.2%) failures over the 15 year period were identified. Of these, 36% were revised within one year and 56% were revised within 2 years of primary TKA. Periprosthetic joint infection (PJI) encompassed 48% of all reasons for revision, followed by aseptic loosening (15%), secondary patella resurfacing (14%), tibio-femoral instability (9%), stiffness (5%), polyethylene wear (2.5%), periprosthetic fracture (2.3%), patella maltracking (1.9%) and extensor mechanism discontinuity (0.9%). In the first 5 years following primary TKA, the most common reason for revision was PJI (52%), from 5-10 years PJI and aseptic loosening (35% each), and from 10-15 years aseptic loosening (41%).

Conclusion:

In this large cohort of patients with comprehensive follow up, PJI was the dominant reason for failure particularly in the first 10 years. Aseptic loosening becomes more important after 10 years follow up. Efforts to improve outcomes following primary TKA should focus on these areas, particularly prevention of PJI.
Success of Debridement and Implant Retention for Periprosthetic Joint Infection in TKA – Does The Surgeon Matter?
Authors: Young Simon W , Zhu Mark , Ravi Saiprasad , Cowley Richard , Luey Chris
Published: May 2017

Introduction:

Prosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). In acute haematogenous and early post-operative PJI, debridement and implant retention (DAIR) is often the initial treatment and reported success rates vary. The aim of this study was to identify factors affecting the success of DAIR and in particular whether involvement of a lower limb arthroplasty surgeon (LLA) can affect outcome.

Method:

In a multicentre review over a 15 year period we identified 137 patients undergoing DAIR for first episode PJI following primary TKA at one of three tertiary hospitals. Patients receiving arthroscopic washouts, culture negative PJI, and previous PJIs were excluded. Data on patient, hospital, and surgical factors were identified including age of implant, time to theatre, presence of gross purulence, bacterial subtype, inflammatory markers, relevant comorbidities, whether modular component exchange was performed, and whether a lower limb arthroplasty surgeon performed the procedure. Treatment success was defined as infection eradication characterized by no clinical failure (healed wound and painless joint) or infection recurrence, and no mortality or further surgery due to PJI within minimum two-year follow up post DAIR. Multivariate analysis was performed using a logistic regression model to identify factors associated with successful DAIR.

Results:

Overall failure rate of DAIR in TKA was 42%. A specialist arthroplasty surgeon was present in 49% of cases. Arthroplasty surgeons performed modular exchange in 92% of cases compared to 57% for other surgeons (RR1.6, P <0.01). On multivariate analysis, involvement of a specialist arthroplasty surgeon was the only factor associated with a significant increase in success of DAIR (OR 2.94, P=0.01). Age of prosthesis less than 90 days and the lack of macroscopic purulence (OR 2.44, p=0.04) increased DAIR success on univariate analysis only.

Conclusions:

Involvement of a specialist arthroplasty surgeon was associated with a 2.9 times higher success rate for DAIR in TKA. Specialist arthroplasty surgeons were more likely to perform modular exchange. This study suggests surgical technique and thorough debridement is likely to be important to the success of DAIR in TKA.
Femoral Stress Fracture Following Meniscal Failure
Authors: Witherow Dr Greg
Published: May 2017

Objectives:

To discuss the effect of meniscal failure.

Methods:

A presentation of a series of cases followed by a literature review and conclusion

Results:

A presentation of a series of cases of femoral fracture following arthroscopic meniscectomy and also after failure of meniscal function following a tear. A review of the historical perspectives of the causes of the condylar breakdown. A discussion of the likely cause of femoral condylar fracture and its management.

Conclusion:

An understanding of the effect of loss of meniscal function and the patients who are at risk.
The Complimentary Contributions of the Anterolateral Ligament and the Lateral Meniscus to the Control of Rotational Knee Laxity
Authors: Lording Tim , Corbo Gillian , Burkhart Tim , Getgood Alan
Published: May 2017

Objectives:

Anatomical studies consistently describe an anatomical connection between the anterolateral ligament (ALL) and the lateral meniscus. The aim of this study was to investigate the role of the ALL and lateral meniscal posterior root (LMPR) in internal rotational (IR) control in the ACL deficient knee.

Methods:

Sixteen cadaveric knees were potted into a hip simulator proximally and a six degree of freedom load cell distally. Positional data for femur and tibia were collected using a navigation system. Testing was performed in 15° increments from extension to 90° of flexion under a 5 Nm internal rotational torque. Specimens were tested in the intact state and after division of the ACL (ACL-), before randomization to division of the ALL (ALL-/M+) or LMPR (ALL+/M-), and finally after division of the remaining structure (ALL-/LMPR-). A one-way ANOVA was performed for each sectioning condition at each knee flexion angle (α = 0.05).

Results:

In extension, there was no significant increase in IR after division of the ACL. After division of the LMPR, there was a significant increase in IR compared to the intact state of 2.93° (p<0.05). Division of the ALL caused only a small increase in IR compared to the intact state (0.87°, NS). Division of the ALL after the LMPR caused no additional increase in IR. At 30° flexion, division of the ALL caused a greater magnitude increase in IR when compared to the intact state than division of the LMPR (4.04° vs 1.32°), although neither reached statistical significance. At 45° flexion, division of the ALL increased IR compared to the intact state by 10.92° (p<0.05), whilst IR caused by division of the PRLM did not reach significance. This pattern of ALL dominance was maintained at 60° and 75° of knee flexion, where the increase in IR was significant compared to both the intact and ACL deficient states.

Discussion:

The ALL and LMPR demonstrate complimentary roles in the control of internal rotation, with the meniscal root more important near extension and the ALL beyond 30° of flexion. These results do not support anatomical ALL reconstruction for control of the pivot shift. LMPR repair may improve stability and have benefits for chondroprotection.
Multifocal brain involvement in a patient with hairy cell leukemia successfully treated with rituximab and cladribine
Authors: Perry Anamarija M. , Matsuda Kant , Wadhwa Vikram , Hewitt Donna , Almiski Muhamad , Johnston James B. , Banerji Versha
Published: May 2017

Key Points

Brain involvement, although rare, can occur in HCL. The combination of cladribine and rituximab is a highly effective treatment of HCL with brain involvement.
RETRACTED ARTICLE: Is early intervention using Mansoura-VV uterine compression sutures an effective procedure in the management of primary atonic postpartum hemorrhage? : a prospective study
Authors: El Refaeey Abd Elaziz A. , Abdelfattah Hosam , Mosbah Alaa , Gamal Anas M. , Fayla Emad , Refaie Waleed , Zaied Abdelhady , Barakat Rafik I. , Seleem Amal K. , Maher Mohammed
Published: May 2017

Background

Postpartum hemorrhage is the leading cause of maternal death, uterine atony accounts for 75-90% of primary postpartum hemorrhage. The efficacy of the Uterine compression suture in the treatment of atonic postpartum hemorrhage is time-tested and can be said to be almost established.The aim of this study was to assess the role of the Mansoura-VV uterine compression suture as an early intervention in the management of primary atonic postpartum hemorrhage.

Methods

This prospective observational study included 108 women with primary atonic PPH over a period of 44 months. Uterine atony was diagnosed when the uterus was soft and failed to respond to ordinary ecbolics. Early intervention by Mansoura-VV uterine compression sutures was carried out within 15 min of the second dose of ecobolics and before progressing to any further surgical procedure.

Results

Following the Mansoura-VV uterine compression sutures, uterine bleeding was controlled in all except one patient (107/108 cases; 99.07%) who required additional bilateral uterine vessels ligation. Another case (0.93%) was subjected to re-laparotomy due to intraperitoneal hemorrhage. Packed RBC transfusion was needed in 10 cases (9.25%). Admission to ICU was needed in 9 cases (8.33%) because of associated medical conditions. One week following the procedure, 1 case (0.93%) was diagnosed with haematometra.

Conclusion

Early intervention in cases of primary atonic PPH using the Mansoura-VV uterine compression sutures is an easy, rapid and effective method in controlling PPH in low resource settings.

Trial registration

The study was registered at clinicaltrial.gov, Identifiers: NCT03117647 “retrospectively registererd” registered at April 7, 2017.
Patterns of regional recurrence in papillary thyroid cancer patients with lateral neck metastases undergoing neck dissection
Authors: Xu Jason J. , Yu Eugene , McMullen Caitlin , Pasternak Jesse , Brierley Jim , Tsang Richard , Zhang Han , Eskander Antoine , Rotstein Lorne , Sawka Anna M. , Gilbert Ralph , Irish Jonathan , Gullane Patrick , Brown Dale , de Almeida John R. , Goldstein David P.
Published: May 2017

Background

Practice variability exists for the extent of neck dissection undertaken for papillary thyroid carcinoma (PTC) metastatic to the lateral neck nodes, with disagreement over routine level V dissection.

Methods

We performed a retrospective medical record review of PTC patients with lateral neck nodal metastases treated at University Health Network from 2000 to 2012. Predictive factors for regional neck recurrence, including extent of initial neck dissection, were analyzed using Cox regression.

Results

Out of 204 neck dissections in 178 patients, 110 (54%) underwent selective and 94 (46%) had comprehensive dissection including level Vb. Mean follow-up was 6.3 years (SD). Significant predictors of regional failure were the total number of suspicious nodes on preoperative imaging ( p = 0.029), largest positive node on initial neck dissection ( p < 0.01), and whether patients received adjuvant radiotherapy ( p = 0.028). The 5-year ipsilateral regional recurrence rate was 8 and 9% with selective and comprehensive dissection, respectively ( p = 0.89).

Conclusion

The extent of neck dissection did not predict the probability of regional recurrence in PTC patients presenting with lateral neck metastases.
College student perceptions about the incorporation of cultural elements in fashion design
Authors: Yen Hui-Yun , Hsu Chiu-I
Published: May 2017

The cultural and creative industries have received considerable global attention in recent years; in particular, the close relationship between these industries and design has been identified. Because mysterious and attractive East Asian aesthetic are a crucial contemporary style, this study examined a fashion exhibition held in the New York Metropolitan Museum, which entitled “China: Through the Looking Glass” and conducted a literature review, scale design, survey and data analysis, and factor analysis about the incorporation of cultural elements in fashion design. Subsequently, the perceptions of college students with various educational backgrounds on several selected exhibits were identified and analyzed. The results were revealed that: (1) the research scale can be used as a reference for related design teaching and in the appraisal of fashion products in the design industry; (2) cultural connotations are more notable in design than the technical aspects; (3) compared with students of other backgrounds, students with a background in fashion design emphasized more on the technical and professional aspects and expressed a preference for design pieces with experimental qualities, such as those made with stiff materials and having exaggerated styles, and neutral and neat straight lines.
Bodies Hardened for War: Knighthood in Fifteenth-Century England
Authors: Bruso Steven
Published: May 2017

This essay examines representations of knightly physicality in two fifteenth-century English texts: the Middle English Secreta Secretorum and Knyghthode and Bataile. These neglected texts are examples of mirrors for princes and Vegetian military manuals, respectively, and both of these genres were standard reading for fifteenth-century English readers ranging from gentry to royal families. Even if they were not knights, many in this audience saw themselves in knightly terms, making it useful to pair these texts to consider how knightly bodies were represented to such an audience. Long before large, muscled male bodies were popularized in 1980s and 1990s action cinema, these medieval texts foreground the necessity of building muscular bodies to knightly identity, while simultaneously describing them through a rhetoric of hardness that characterized their envisioned use as physical and psychological weapons.
A Once and Future King: Sanctuary, Sovereignty, and the Politics of Pity in the Histories of Perkin Warbeck
Authors: Allen Elizabeth
Published: May 2017

John Ford's play Perkin Warbeck uses sanctuary, which bookends the life of the titular pretender to the English throne, as a figure for the tension between justice and mercy. The play associates legal sanctuary with the medieval past, as crystallized in Thomas More's account of Richard Plantagenet's extraction from sanctuary at Westminster in The History of Richard III (1557). Moreover, Ford redirects the language of contemporary chroniclers Francis Bacon and Thomas Gainsford in order to emphasize the link between sanctuary and practices of royal pity in the play. By positioning itself between a myth of medieval kingship as limited, contingent, and responsive to human need, on the one hand, and on the other, a myth of Tudor pragmatism as a sovereign assertion of law, the play offers two alternatives to the absolutism of Stuart monarchy without endorsing either.
Heat-resistant cytosolic malate dehydrogenases (cMDHs) of thermophilic intertidal snails (genus Echinolittorina): protein underpinnings of tolerance to body temperatures reaching 55°C
Authors: Liao Ming-ling , Zhang Shu , Zhang Guang-ya , Chu Yun-meng , Somero George N. , Dong Yun-wei
Published: May 2017

Snails of the genus Echinolittorina are among the most heat-tolerant animals; they experience average body temperatures near 41–44°C in summer and withstand temperatures up to at least 55°C. Here, we demonstrate that heat stability of function (indexed by the Michaelis–Menten constant of the cofactor NADH, KMNADH) and structure (indexed by rate of denaturation) of cytosolic malate dehydrogenases (cMDHs) of two congeners (E. malaccana and E. radiata) exceeds values previously found for orthologs of this protein from less thermophilic species. The ortholog of E. malaccana is more heat stable than that of E. radiata, in keeping with the congeners' thermal environments. Only two inter-congener differences in amino acid sequence in these 332 residue proteins were identified. In both cases (positions 48 and 114), a glycine in the E. malaccana ortholog is replaced by a serine in the E. radiata protein. To explore the relationship between structure and function and to characterize how amino acid substitutions alter stability of different regions of the enzyme, we used molecular dynamics simulation methods. These computational methods allow determination of thermal effects on fine-scale movements of protein components, for example, by estimating the root mean square deviation in atom position over time and the root mean square fluctuation for individual residues. The minor changes in amino acid sequence favor temperature-adaptive change in flexibility of regions in and around the active sites. Interspecific differences in effects of temperature on fine-scale protein movements are consistent with the differences in thermal effects on binding and rates of heat denaturation.
ADAR RNA editing below the backbone
Authors: Keegan Liam , Khan Anzer , Vukic Dragana , O'Connell Mary
Published: May 2017

ADAR RNA editing enzymes (adenosine deaminases acting on RNA) that convert adenosine bases to inosines were first identified biochemically 30 years ago. Since then, studies on ADARs in genetic model organisms, and evolutionary comparisons between them, continue to reveal a surprising range of pleiotropic biological effects of ADARs. This review focuses on Drosophila melanogaster, which has a single Adar gene encoding a homolog of vertebrate ADAR2 that site-specifically edits hundreds of transcripts to change individual codons in ion channel subunits and membrane and cytoskeletal proteins. Drosophila ADAR is involved in the control of neuronal excitability and neurodegeneration and, intriguingly, in the control of neuronal plasticity and sleep. Drosophila ADAR also interacts strongly with RNA interference, a key antiviral defense mechanism in invertebrates. Recent crystal structures of human ADAR2 deaminase domain–RNA complexes help to interpret available information on Drosophila ADAR isoforms and on the evolution of ADARs from tRNA deaminase ADAT proteins. ADAR RNA editing is a paradigm for the now rapidly expanding range of RNA modifications in mRNAs and ncRNAs. Even with recent progress, much remains to be understood about these groundbreaking ADAR RNA modification systems.
Nitric oxide signalling and neuronal nitric oxide synthase in the heart under stress
Authors: Zhang Yin Hua
Published: May 2017

Nitric oxide (NO) is an imperative regulator of the cardiovascular system and is a critical mechanism in preventing the pathogenesis and progression of the diseased heart. The scenario of bioavailable NO in the myocardium is complex: 1) NO is derived from both endogenous NO synthases (endothelial, neuronal, and/or inducible NOSs [eNOS, nNOS, and/or iNOS]) and exogenous sources (entero-salivary NO pathway) and the amount of NO from exogenous sources varies significantly; 2) NOSs are located at discrete compartments of cardiac myocytes and are regulated by distinctive mechanisms under stress; 3) NO regulates diverse target proteins through different modes of post-transcriptional modification (soluble guanylate cyclase [sGC]/cyclic guanosine monophosphate [cGMP]/protein kinase G [PKG]-dependent phosphorylation, S-nitrosylation, and transnitrosylation); 4) the downstream effectors of NO are multidimensional and vary from ion channels in the plasma membrane to signalling proteins and enzymes in the mitochondria, cytosol, nucleus, and myofilament; 5) NOS produces several radicals in addition to NO (e.g. superoxide, hydrogen peroxide, peroxynitrite, and different NO-related derivatives) and triggers redox-dependent responses. However, nNOS inhibits cardiac oxidases to reduce the sources of oxidative stress in diseased hearts. Recent consensus indicates the importance of nNOS protein in cardiac protection under pathological stress. In addition, a dietary regime with high nitrate intake from fruit and vegetables together with unsaturated fatty acids is strongly associated with reduced cardiovascular events. Collectively, NO-dependent mechanisms in healthy and diseased hearts are better understood and shed light on the therapeutic prospects for NO and NOSs in clinical applications for fatal human heart diseases.
Metabolic reprogramming during the Trypanosoma brucei life cycle
Authors: Smith Terry K. , Bringaud Frédéric , Nolan Derek P. , Figueiredo Luisa M.
Published: May 2017

Cellular metabolic activity is a highly complex, dynamic, regulated process that is influenced by numerous factors, including extracellular environmental signals, nutrient availability and the physiological and developmental status of the cell. The causative agent of sleeping sickness,Trypanosoma brucei, is an exclusively extracellular protozoan parasite that encounters very different extracellular environments during its life cycle within the mammalian host and tsetse fly insect vector. In order to meet these challenges, there are significant alterations in the major energetic and metabolic pathways of these highly adaptable parasites. This review highlights some of these metabolic changes in this early divergent eukaryotic model organism.
Protein-bound polyphenols create “ghost” band artifacts during chemiluminescence-based antigen detection
Authors: Plundrich Nathalie , Lila Mary Ann , Foegeding Edward , Laster Scott
Published: May 2017

Antigen detection during Western blotting commonly utilizes a horseradish peroxidase-coupled secondary antibody and enhanced chemiluminescent substrate. We utilized this technique to examine the impact of green tea-derived polyphenols on the binding of egg white protein-specific IgE antibodies from allergic human plasma to their cognate antigens. Our experiments unexpectedly showed that green tea-derived polyphenols, when stably complexed with egg white proteins, caused “ghost” band formation in the presence of horseradish peroxide. This study suggests that caution should be taken when evaluating polyphenol-bound proteins by enhanced chemiluminescence Western blotting using horseradish peroxidase and demonstrates that protein-bound polyphenols can be a source of “ghost” band artifacts on Western blots.