bluuebunny/crossref_metadata_2025_split huggingface dataset:
Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques
Authors: Deckey David G. , Rosenow Christian S. , Verhey Jens T. , Brinkman Joseph C. , Mayfield Cory K. , Clarke Henry D. , Bingham Joshua S. 
Published: May 2021

Aims Robotic-assisted total knee arthroplasty (RA-TKA) is theoretically more accurate for component positioning than TKA performed with mechanical instruments (M-TKA). Furthermore, the ability to incorporate soft-tissue laxity data into the plan prior to bone resection should reduce variability between the planned polyethylene thickness and the final implanted polyethylene. The purpose of this study was to compare accuracy to plan for component positioning and precision, as demonstrated by deviation from plan for polyethylene insert thickness in measured-resection RA-TKA versus M-TKA. Methods A total of 220 consecutive primary TKAs between May 2016 and November 2018, performed by a single surgeon, were reviewed. Planned coronal plane component alignment and overall limb alignment were all 0° to the mechanical axis; tibial posterior slope was 2°; and polyethylene thickness was 9 mm. For RA-TKA, individual component position was adjusted to assist gap-balancing but planned coronal plane alignment for the femoral and tibial components and overall limb alignment remained 0 ± 3°; planned tibial posterior slope was 1.5°. Mean deviations from plan for each parameter were compared between groups for positioning and size and outliers were assessed. Results In all, 103 M-TKAs and 96 RA-TKAs were included. In RA-TKA versus M-TKA, respectively: mean femoral positioning (0.9° (SD 1.2°) vs 1.7° (SD 1.1°)), mean tibial positioning (0.3° (SD 0.9°) vs 1.3° (SD 1.0°)), mean posterior tibial slope (-0.3° (SD 1.3°) vs 1.7° (SD 1.1°)), and mean mechanical axis limb alignment (1.0° (SD 1.7°) vs 2.7° (SD 1.9°)) all deviated significantly less from the plan (all p < 0.001); significantly fewer knees required a distal femoral recut (10 (10%) vs 22 (22%), p = 0.033); and deviation from planned polyethylene thickness was significantly less (1.4 mm (SD 1.6) vs 2.7 mm (SD 2.2), p < 0.001). Conclusion RA-TKA is significantly more accurate and precise in planning both component positioning and final polyethylene insert thickness. Future studies should investigate whether this increased accuracy and precision has an impact on clinical outcomes. The greater accuracy and reproducibility of RA-TKA may be important as precise new goals for component positioning are developed and can be further individualized to the patient. Cite this article: Bone Joint J 2021;103-B(6 Supple A):74–80.
Differences in time to return to work among patients undergoing simultaneous versus staged bilateral total knee arthroplasty
Authors: Kahlenberg Cynthia A. , Krell Ethan C. , Sculco Thomas P. , Katz Jeffrey N. , Nguyen Joseph T. , Figgie Mark P. , Sculco Peter K. 
Published: May 2021

Aims Many patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis (OA) in both knees and may consider either simultaneous or staged bilateral TKA. The implications of simultaneous versus staged bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared with the sum of days missed from each operation for patients who underwent staged bilateral TKA. Methods The prospective arthroplasty registry at the Hospital for Special Surgery was used. Baseline characteristics and patient-reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounding variables including age, sex, preoperative BMI, and type of work (sedentary, moderate, high activity, or strenuous), to analyze time lost from work after simultaneous compared with staged bilateral TKA. Results We identified 152 employed patients who had undergone simultaneous bilateral TKA and 61 who had undergone staged bilateral TKA, and had completed the registry’s return to work questionnaire. The simultaneous group missed a mean of 46.2 days (SD 29.1) compared with the staged group who missed a mean total of 68.0 days of work (SD 46.1) when combining both operations. This difference was statistically significant (p < 0.001). In multivariate mixed regression analysis adjusted for age, sex, BMI, American Society of Anesthesiologists status, and type of work, the simultaneous group missed a mean of 16.9 (SD 5.7) fewer days of work compared with the staged group (95% confidence interval 5.8 to 28.1; p = 0.003). Conclusion Employed patients undergoing simultaneous bilateral TKA missed a mean of 17 fewer days of work as a result of their surgical treatment and rehabilitation compared with those undergoing staged bilateral TKA. This information may be useful to surgeons counselling employed patients with bilateral OA of the knee who are considering surgical treatment. Cite this article: Bone Joint J 2021;103-B(6 Supple A):108–112.
Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty
Authors: Gausden Elizabeth B. , Shirley Matthew B. , Abdel Matthew P. , Sierra Rafael J. 
Published: May 2021

Aims To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an acute, traumatic wound dehiscence following total knee arthroplasty (TKA). Methods From January 2002 to December 2018, 16,134 primary TKAs were performed at a single institution. A total of 26 patients (0.1%) had a traumatic wound dehiscence within the first 30 days. Mean age was 68 years (44 to 87), 38% (n = 10) were female, and mean BMI was 34 kg/m2 (23 to 48). Median time to dehiscence was 13 days (interquartile range (IQR) 4 to 15). The dehiscence resulted from a fall in 22 patients and sudden flexion after staple removal in four. The arthrotomy was also disrupted in 58% (n = 15), including a complete extensor mechanism disruption in four knees. An irrigation and debridement with component retention (IDCR) was performed within 48 hours in 19 of 26 knees and two-thirds were discharged on antibiotic therapy. The mean follow-up was six years (2 to 15). The association of wound dehiscence and the risk of developing a PJI was analyzed. Results Patients who sustained a traumatic wound dehiscence had a 6.5-fold increase in the risk of PJI (95% confidence interval (CI) 1.6 to 26.2; p = 0.008). With the small number of PJIs, no variables were found to be significant risk factors. However, there were no PJIs in any of the patients who were treated with IDCR and a course of antibiotics. Three knees required reoperation including one two-stage exchange for PJI, one repeat IDCR for PJI, and one revision for aseptic loosening of the tibial component. Conclusion Despite having a traumatic wound dehiscence, the risk of PJI was low, but much higher than experienced in all other TKAs during the same period. We recommend urgent IDCR and a course of postoperative antibiotics to decrease the risk of PJI. A traumatic wound dehiscence increases risk of PJI by 6.5-fold. Cite this article: Bone Joint J 2021;103-B(6 Supple A):191–195.
Cobalt-chromium femoral components developed scratches and released metal debris in simulated wear whereas ceramic femoral components did not
Authors: Roy Marie E. , Whiteside Leo A. , Ly Kevin K. , Gauvain Matthew J. 
Published: May 2021

Aims The aims of this study were to evaluate wear on the surface of cobalt-chromium (CoCr) femoral components used in total knee arthroplasty (TKA) and compare the wear of these components with that of ceramic femoral components. Methods Optical profilometry was used to evaluate surface roughness and to examine the features created by the wear process in a knee wear simulator. We developed a method of measuring surface changes on five CoCr femoral components and quantifying the loss of material from the articular surface during the wear process. We also examined the articular surface of three ceramic femoral components from a previous test for evidence of surface damage, and compared it with that of CoCr components. Results We found that the surface roughness of CoCr components rapidly increased during the first 1,000 wear cycles, then reached a steady state, but material loss from the surface continued at a rate of 1,778,000 μm3 per million cycles as carbides were removed from its matrix. These carbides formed third-body wear particles, leading to the formation of new scratches even as older scratches were worn away. In contrast, no scratching, loss of material, or other surface damage, when evaluated with one nanometer resolution, was found on the surface of the ceramic components after a 15 M wear cycle test. Conclusion This study showed wear and loss of CoCr material from scratching and microabrasive wear in TKA. The material loss from the surface continued in a linear relationship with increasing cycles. We also found the absence of scratching and roughening of ceramic femoral components in simulated wear, suggesting an advantage in wear rate and avoiding metal sensitivity. This may have implications in the management of persistent pain after TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):94–101.
Social determinants of health in total knee arthroplasty
Authors: Delanois Ronald E. , Tarazi John M. , Wilkie Wayne A. , Remily Ethan , Salem Hytham S. , Mohamed Nequesha S. , Pollack Andrew N. , Mont Michael A. 
Published: May 2021

Aims Social determinants of health (SDOHs) may contribute to the total cost of care (TCOC) for patients undergoing total knee arthroplasty (TKA). The aim of this study was to investigate the association between demographic data, health status, and SDOHs on 30-day length of stay (LOS) and TCOC after this procedure. Methods Patients who underwent TKA between 1 January 2018 and 31 December 2019 were identified. A total of 234 patients with complete SDOH data were included. Data were drawn from the Chesapeake Regional Information System, the Centers for Disease Control social vulnerability index (SVI), the US Department of Agriculture, and institutional electronic medical records. The SVI identifies areas vulnerable to catastrophic events with four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. Food deserts were defined as neighbourhoods located one or ten miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine associations with LOS and costs after controlling for various demographic parameters. Results Divorced status was significantly associated with an increased LOS (p = 0.043). Comorbidities significantly associated with an increased LOS included chronic obstructive pulmonary disease/asthma and congestive heart failure (p = 0.043 and p = 0.001, respectively). Communities with a higher density of tobacco stores were significantly associated with an increased LOS (p = 0.017). Comorbidities significantly associated with an increased TCOC included chronic obstructive pulmonary disease (p = 0.004), dementia (p = 0.048), and heart failure (p = 0.007). Increased TCOCs were significantly associated with patients who lived in food deserts (p = 0.001) and in areas with an increased density of tobacco stores (p = 0.023). Conclusion Divorced marital status was significantly associated with an increased LOS following TKA. Living in food deserts and in communities with more tobacco stores were significant risk factors for increased LOS and TCOC. Food access and ease of acquiring tobacco may both prove to be prognostic of outcome after TKA and an opportunity for intervention. Cite this article: Bone Joint J 2021;103-B(6 Supple A):113–118.
3D-printed titanium metaphyseal cones in revision total knee arthroplasty with cemented and cementless stems
Authors: Anderson Lucas A. , Christie Matthew , Blackburn Brenna E. , Mahan Chad , Earl Christian , Pelt Christopher E. , Peters Christopher L. , Gililland Jeremy 
Published: May 2021

Aims Porous metaphyseal cones can be used for fixation in revision total knee arthroplasty (rTKA) and complex TKAs. This metaphyseal fixation has led to some surgeons using shorter cemented stems instead of diaphyseal engaging cementless stems with a potential benefit of ease of obtaining proper alignment without being beholden to the diaphysis. The purpose of this study was to evaluate short term clinical and radiographic outcomes of a series of TKA cases performed using 3D-printed metaphyseal cones. Methods A retrospective review of 86 rTKAs and nine complex primary TKAs, with an average age of 63.2 years (SD 8.2) and BMI of 34.0 kg/m2 (SD 8.7), in which metaphyseal cones were used for both femoral and tibial fixation were compared for their knee alignment based on the type of stem used. Overall, 22 knees had cementless stems on both sides, 52 had cemented stems on both sides, and 15 had mixed stems. Postoperative long-standing radiographs were evaluated for coronal and sagittal plane alignment. Adjusted logistic regression models were run to assess malalignment hip-knee-ankle (HKA) alignment beyond ± 3° and sagittal alignment of the tibial and femoral components ± 3° by stem type. Results No patients had a revision of a cone due to aseptic loosening; however, two had revision surgery due to infection. In all, 26 (27%) patients had HKA malalignment; nine (9.5%) patients had sagittal plane malalignment, five (5.6%) of the tibia, and four (10.8%) of the femur. After adjusting for age, sex, and BMI, there was a significantly increased risk for malalignment when a cone was used and both the femur and tibia had cementless compared to cemented stems (odds ratio 3.19, 95% confidence interval 1.01 to 10.05). Conclusion Porous 3D-printed cones provide excellent metaphyseal fixation. However, these central cones make the use of offset couplers difficult and may generate malalignment with cementless stems. We found 3.19-times higher odds of malalignment in our TKAs performed with metaphyseal cones and both femoral and tibial cementless stems. Cite this article: Bone Joint J 2021;103-B(6 Supple A):150–157.
Cobalt-induced cardiomyopathy – do circulating cobalt levels matter?
Authors: Jenkinson Mark R. J. , Meek R. M. Dominic , Tate Rothwell , MacMillan Sandy , Grant M. Helen , Currie Susan 
Published: May 2021

Elevated levels of circulating cobalt ions have been linked with a wide range of systemic complications including neurological, endocrine, and cardiovascular symptoms. Case reports of patients with elevated blood cobalt ions have described significant cardiovascular complications including cardiomyopathy. However, correlation between the actual level of circulating cobalt and extent of cardiovascular injury has not previously been performed. This review examines evidence from the literature for a link between elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties and cardiomyopathy. Correlation between low, moderate, and high blood cobalt with cardiovascular complications has been considered. Elevated blood cobalt at levels over 250 µg/l have been shown to be a risk factor for developing systemic complications and published case reports document cardiomyopathy, cardiac transplantation, and death in patients with severely elevated blood cobalt ions. However, it is not clear that there is a hard cut-off value and cardiac dysfunction may occur at lower levels. Clinical and laboratory research has found conflicting evidence of cobalt-induced cardiomyopathy in patients with MoM hips. Further work needs to be done to clarify the link between severely elevated blood cobalt ions and cardiomyopathy. Cite this article: Bone Joint Res 2021;10(6):340–347.
Chicken or the thumb? Comparing chicken femora with human metacarpals
Authors: Sargazi N , Oskrochi Y , Houghton J , Rai B , Brown D , Cheung G 
Published: May 2021

Introduction While the gold standard for simulation training in hand surgery is cadaveric hands, ethical issues and cost limit their use. Chicken thighbones have been utilised to replicate human metacarpals but there is a lack of literature to validate such a model. The aim of this study was to determine whether chicken femurs are morphologically similar to human metacarpal bones. Methods Computed tomography imaging was obtained of hands undertaken at our institute between 1 January and 31 December 2015. A total of 114 chicken thighs were also scanned. Bones with previous trauma or incomplete imaging were excluded. Bone length, distance to isthmus, radius of curvature, medullary canal diameter and cortical thickness were compared between the groups. Statistical analysis was conducted using Student’s t-test or the Mann-Whitney U test, with statistical significance implied with a p-value of < 0.05. Results A total of 146 human CT scans were identified, of which 36 were included in the study, resulting in 158 human metacarpals in 5 female and 31 male patients, with an average age of 39.5 years (range: 16–77 years). Of 114 chickens scanned, 101 were suitable for analysis. Mean length, distance to isthmus, radius of curvature, medullary canal diameter and cortical thickness were 57.3mm (standard deviation [SD]: 8.7mm), 32.9mm (SD: 8.2mm), 68.8mm (SD: 19.5mm), 9.3mm (SD: 1.6mm) and 1.7mm (SD: 0.4mm) respectively in human metacarpals, compared with 66.7mm (SD: 5.1mm), 34.1mm (SD: 6.4mm), 89.1mm (SD: 15.1mm), 6.4mm (SD: 0.6mm) and 1.6mm (SD: 0.1mm) respectively in chicken femurs. There was no significant difference in bone geometry between the groups, with p-values of >0.05 for all parameters described. Conclusions The chicken thigh model provides an anatomically suitable and more cost effective alternative to human cadaveric metacarpals in simulation training for hand surgery.
Overcoming challenges in septorhinoplasty training faced by UK otorhinolaryngology trainees
Authors: Oremule B , Khwaja S , Saleh HA 
Published: May 2021

Introduction The aim of this study was to assess UK otorhinolaryngology trainees’ perceptions of their septorhinoplasty training. The possible effects that the COVID-19 pandemic may have on current and future training opportunities are also discussed. Methods A cross-sectional survey of members of the Association of Otolaryngologists in Training was conducted in March 2019. Results A total of 64 trainees responded to the survey. All deaneries were represented. A variety of challenges regarding septorhinoplasty training were highlighted. The most common hurdle was the low number of cases being undertaken. A third of the ST7–ST8 trainees in this sample (8/25, 32%) had not yet performed a single septorhinoplasty even though they were into the final two years of their training. Conclusions The COVID-19 pandemic is a new additional threat to septorhinoplasty training for otorhinolaryngology trainees, particularly those in the final two years of the programme. In the short term, clarification is needed regarding what level of operative proficiency is required for the Certificate of Completion of Training. In the longer term, threats to training can be mitigated by providing cadaveric courses, embracing simulation and considering private sector placements in areas of low NHS volume.
Obsidian from the Site of Piano dei Cardoni, Ustica (Palermo, Italy): Preliminary Results on the First Occupation of the Island
Authors: Speciale Claudia , Freund Kyle P. , de Vita Sandro , Larosa Nunzia , Forgia Vincenza , Battaglia Giuseppina , Tykot Robert H. , Vassallo Stefano 
Published: May 2021

Abstract
New investigations on Ustica (Palermo, Sicily) originated from the need to improve our knowledge of the island’s archaeological and environmental heritage. Through field surveys, particular attention was paid to human occupation in the Neolithic phases and focused on the less investigated southern side of the island. The systematic survey of the area of Piano dei Cardoni in 2018 brought to light a new Middle/Late Neolithic site, already partially documented in the literature. The island was settled for the first time during these phases, as also testified from the area of Punta Spalmatore. The presence of Serra d’Alto, incised dark burnished, and Diana styles suggests that the site and the archaeological assemblage dates from the mid to late 5th millennium BC, as confirmed by AMS dating. In addition to pottery, obsidian artifacts were also recovered, and a preliminary study of these materials is presented here. Portable XRF analyses on a sample of 41 obsidian artifacts, representing a high percentage of the lithic assemblage compared to chert tools, show that the provenance of the raw material is Gabellotto Gorge (Lipari) and Balata dei Turchi (Pantelleria). These results provide new insight into broader regional debates about obsidian technology and its exchange during the Neolithic and open an important consideration for sites that are far from the raw material sources.
Surface levels of organic conductors in a tilted in-plane magnetic field
Authors: Krstovska Danica , Skeparovski Aleksandar 
Published: May 2021

Abstract
Surface quantum states in quasi-two dimensional organic conductors induced by an external magnetic field tilted in the plane of the layers are obtained and analyzed. In tilted magnetic fields, these states arise from the transitions of the electrons between the closed orbits on the sides of the Fermi surface determined by the electron momentum along the magnetic field direction p

B
and the coordinate of the center of electron revolution Z. By far, in organic conductors, the surface states have not been studied for tilted magnetic fields. In this work, we have performed detail analyses of the surface states in a tilted in-plane magnetic field by calculating the surface energy spectrum and surface wave functions in order to address their properties and features. We find that, in a tilted magnetic field, the surface levels have higher energies compared to those at zero tilt angle but can be observed only up to a certain tilt angle. The resonant magnetic field and angular values at which the peaks in the surface oscillations should be observed are obtained. Further theoretical and new experimental studies of the surface states in a tilted magnetic field might give new insights into the surface properties of quasi-two dimensional organic conductors. Additionally, they may reveal new information about the parameters of the Fermi surface of organic conductors necessary for its reconstruction.