bluuebunny/crossref_metadata_2025_split huggingface dataset:
Harmonizing Health and Fitness with Healthcare Through the U.S. Registry of Exercise Professionals
Authors: Biagioli Brian , Melstrand Graham , Howard Rick 
Published: August 2024

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By reading this article, the reader will learn:
• The importance of collaboration for the national registration system
• How to access the USREPS at https://USREPS.org to see the registry
• How to check their credentials or those of employees on the registry
• How human resource departments can check multiple employees at one time
Asset Pricing with Costly Short Sales
Authors: Hugonnier Julien , Prieto Rodolfo 
Published: August 2024

We study a dynamic general equilibrium model with costly-to-short stocks and heterogeneous beliefs. Costly short sales drive a wedge between the valuation of assets that promise identical cash flows but that are subject to different trading arrangements. In particular, we show that the price of an asset is given by the risk-adjusted present value of its future cash flows, which include both dividends and an endogenous lending yield that we characterize explicitly. This valuation formula implies that stocks with low and high shorting costs should offer similar risk-return trade-off once returns are appropriately adjusted for lending revenues and thus, sheds light on recent empirical findings about the explanatory power of shorting costs in the cross-section of returns. This paper was accepted by Lukas Schmid, finance. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2023.01887 .
LONG-TERM RESULTS OF 331 TWO-STAGE EXCHANGES FOR PERIPROSTHETIC JOINT INFECTION FOLLOWING TOTAL HIP ARTHROPLASTY: LOW REINFECTION AND MECHANICAL FAILURE RATES AT TEN YEARS
Authors: Terhune E. B. , Carstens M. F. , Fruth K. M. , Hannon C. P. , Bedard N. A. , Berry D. J. , Abdel M. P. 
Published: August 2024

The relative advantages and disadvantages of two-stage versus one-stage management of infected total hip arthroplasties are the current subject of intense debate. To understand the merits of each approach detailed information on the short and, importantly, longer-term outcomes of each must be known. The purpose of this study was to assess the long-term results of two-stage exchange arthroplasty for THAs in one of the largest series to date.We identified 331 infected THAs treated with a two-stage exchange arthroplasty between 1993 and 2021 at a single institution. Patients were excluded if they had prior treatment for infection. Mean age at reimplantation was 66 years, 38% were female, and mean BMI was 30 kg/m2. PJI diagnosis was based on the 2011 MSIS criteria. A competing risk model accounting for death was utilized. Mean follow up was 8 years.The cumulative incidence of reinfection was 7% at 1 year and 11% at 5 and 10 years. Factors predictive of reinfection included BMI>30 kg/m2 (HR 2; p=0.049), and need for a spacer exchange (HR 3.2; p=0.006). The cumulative incidence of any revision was 13% at 5 and 10 years. The cumulative incidence of aseptic revision was 3% at 1 year, 7% at 5 years, and 8% at 10 years. Dislocation occurred in 33 hips (11% at 10 years; 45% required revision). Factors predictive of dislocation were female sex (HR 2; p=0.047) and BMI<30 kg/m2 (HR 3; p=0.02). The mean HHS improved from 54 to 75 at 10 years.In this series of 331 two-stage exchange arthroplasties performed for infected hips, we found a low aseptic revision rate (8%) and a low rate of reinfection (11%) at 10 years. These long-term mechanical and infection data must be kept in mind when considering a paradigm shift to one-stage exchanges.Level of Evidence: Level III
A COMPARATIVE ANALYSIS OF 1.5-STAGE AND TWO-STAGE REVISION FOR PERIPROSTHETIC JOINT INFECTION AFTER TOTAL HIP ARTHROPLASTY: IS 1.5-STAGE REALLY EQUIVALENT?
Authors: Hosseinzadeh S. , Rajschmir K. , Villa J. M. , Manrique J. , Riesgo A. M. , Higuera C. A. 
Published: August 2024

Two-stage exchange arthroplasty is traditionally used to treat periprosthetic hip infection. Nevertheless, particularly in high-risk patients, there has been increased attention towards alternatives such as 1.5-stage exchange arthroplasty which takes place in one surgery. Therefore, we sought to compare (1) operative time, length-of-stay (LOS), transfusions, (2) causative organism identification and polymicrobial infection rates, (3) re-revision rates and re-revision reasons, (4) mortality, and determine (5) independent predictors of re-revision.Retrospective chart review of 71 patients who underwent either 1.5- (n=38) or 2-stage (n=33) exchange hip arthroplasty at a single institution (03/2019-05/2023). Demographics, surgical, inpatient, and infection characteristics were noted. Main outcomes evaluated were re-revision rates, re-revision reasons, mortality, and cause of death. Independent predictors of re-revision were assessed utilizing logistic regression. Mean follow: 675 days (range, 23–1,715).Demographics were not significantly different except for a higher proportion of 1.5-stage patients classified as American-Society-of-Anesthesiologists (ASA) status 3 or 4 (84.2 vs. 48.5%, p=0.002). Length of follow-up was significantly longer in the 2-stage group (924.4 vs. 458 days, p<0.001) as well as operative time (506 vs. 271 minutes, p<0.001). In the 1.5-stage group, there was a higher proportion of polymicrobial infections (23.7 vs. 3.0%, p=0.016), re-revision rates (28.9 vs. 9.1%, p=0.042) and periprosthetic infections as a cause of revision (90.9 vs. 0%, p=0.007). Mortality rates were not significantly different, and no patient died for causes related to infection. Type of surgery (1.5-stage vs. 2-stage) was the only independent predictor of re-revision (odds-ratio 4.0, 95% confidence-interval 1.02–16.16, p=0.046).Our data suggests that patients who undergo 1.5-stage exchange arthroplasty have a significantly higher re-revision rate (mostly due to infection) when compared to 2-stage patients. We acknowledge potential benefits of the 1.5-stage strategy, especially in high-risk patients since it involves single surgery. However, higher re-revision rates must be considered when counseling patients.
INTRA-ARTICULAR ANTIBIOTICS FOLLOWING SINGLE-STAGE REVISION FOR PERIPROSTHETIC JOINT INFECTION IN CEMENTLESS TOTAL HIP ARTHROPLASTY ARE EFFECTIVE AND SAFE
Authors: Gevers M. , Vandeputte F.-J. , Welters H. , Corten K. 
Published: August 2024

High doses of intra-articular (IA) antibiotics has been shown to effectively achieve a minimal biofilm eradication concentration which could mitigate the need for removal of infected but well-ingrown cementless components of a total hip arthroplasty (THA). However, there are concerns that percutaneous catheters could lead to multi-resistance or multi-organism peri-prosthetic joint infections (PJI) following single stage THA revisions for PJI.Eighteen single-stage revision procedures were performed for acute (N=9) or chronic (N=9) PJI following a primary (N=12) or revision (N=6) cementless THA. Modular and loosened components were replaced. All well ingrown components were retained. Two Hickmann catheters were placed in the joint space. Along with intravenous antibiotics, IA antibiotics were injected twice a day for two weeks, followed by 3 months of oral antibiotics.Per-operative cultures demonstrated 4 multi-bacterial PJIs. None of the patients developed post-operatively an AB related renal or systemic dysfunction. At a mean follow-up of 38 months [range, 8–72] all patients had normal erythrocyte sedimentation rate and white blood cell count. Four had a slightly elevated C-reactive protein but were completely symptom free and did not show any sign of loosening at a mean of 27 months [range, 16–59].Addition of high doses of IA antibiotics following single-stage revision for PJI in cementless THA, is an effective and safe treatment option that allows for retention of well-ingrown components. We found no evidence for residual implant infection or catheter induced multi-resistance.Total hip arthroplasty, revision surgery, Periprosthetic Joint Infection, Intra-articular antibioticsLevel 4 (Case series)
PREVENTION OF PERIPROSTHETIC JOINT INFECTION THROUGH ELECTROPHORETIC DEPOSITION OF GENTAMICIN INTO TITANIUM NANOTUBES: AN IN VIVO INVESTIGATION
Authors: Hamilton J. L. , Gianotti S. , Impergre A. , AbuAlia M. , Markovics A. , Jacobs J. J. , Valle C. J. Della , Wimmer M. A. 
Published: August 2024

We created TiO2 nanotubes (TNTs) on the surface of titanium (Ti) implants with subsequential loading with gentamicin and chitosan, acting as a control release agent, by electrophoretic deposition (EPD). We hypothesized femoral implants with TNTs loaded with gentamicin and chitosan would localize antibiotic to the implant and surgical site and prevent PJI in a mouse model.Ti-6Al-4V ELI wires underwent TNT surface modification by two-step anodization. EPD was then used to load gentamicin and chitosan onto the Ti wire with surface TNTs. Control Ti wires contained TNTs with EPD of chitosan only. 12-week-old male C57BL/6J mice underwent received a right femoral intramedullary implant followed by inoculation at the surgical site with 1×103 CFUs of bioluminescent Xen36 Staphylococcus aureus (S. aureus). Mice were randomly divided into two implant groups: 1) Gentamicin + Chitosan Group (n=7; experimental group); 2) Chitosan Group (n=7; control group). Outcomes included: 1) Relative S. aureus abundance by bioluminescence imaging; 2) Quantification of S. aureus at the implant and surrounding tissue by colony forming unit (CFU) analysis; 3) Scanning electron microscopy (SEM) for implant bacterial biofilm; 4) Radiographic signs of PJI.Over 14 days assessment following wire implantation and inoculation with S. aureus, the experimental group had no evidence of infection based on i) no increased Xen36 S. aureus bioluminescence signal and ii) no CFUs present. All control had increased bioluminescence signal, above baseline, at all time-points and presence of CFUs.Ti femoral implants modified with surface TNTs and coated with gentamicin and chitosan through EPD prevented PJI in all mice through 14 days. In comparison, all control mice demonstrated evidence of PJI over 14 days. Implants with TNTs and EPD of gentamicin were highly effective in this mouse PJI model.
THE COMBINED USE OF SINGLE- AND DUAL-MOBILITY CUPS IN PRIMARY TOTAL HIP ARTHROPLASTY IS SAFE IN A UNIVERSITY HOSPITAL PRACTICE
Authors: Argenson J.-N. , Peuchot H. , Simmons E. Haynes , Fabre-Aubrespy M. , Jacquet C. , Flecher X. 
Published: August 2024

Dislocation after Total Hip Arthroplasty (THA) is a frequent cause of revision and patients with intrinsic risk factors have been identified. The use of dual mobility (DM) cup has shown great efficiency in preventing dislocation, with questions regarding selective or absolute use. The aim of this study was to compare the outcome of single mobility THA (SM-THA) and DM-THA, when used for selected patients.This retrospective continuous cohort study evaluated 490 patients of whom 275 received SM-THA and 215 received DM-THA. There were 304 primary osteoarthritis (62%), 121 femoral neck fractures (24%) and 65 other indications (14%). The surgical approach was anterior (AA) in 79% and posterior (PA) in 21% of cases. In the DM-THA group, 189 patients (87%) presented at least one dislocation risk factor compared to 128 patients (46%) in the SM-THA group. The primary outcome was revision for all causes, with or without implant removal. Secondary outcomes included length of hospital stay.There was no difference in all cause revision at two years follow up with 9 procedures (3.2%) in SM-THA group and 11 in DM-THA group (5.1%) (p=0.3). There were 3 dislocations in SM-THA group (3 AA) and 3 in DM-THA group (2 PA and 1 AA) (p=0.4).The length of stay was significantly longer in DM-THA group with 7 days (2–12) compared to 4 days (1–7) in SM-THA group (p=0.001).SM-THA and DM-THA are two complementary devices in the management of patients requiring primary THA. SM-THA is a safe option for patients without dislocation risk factors, especially when using AA. The identification of such factors is important to select patients requiring DM-THA and provide reproducible outcomes in a University Hospital practice including various levels of surgeon experience.
TOTAL HIP ARTHROPLASTY IN CHILDREN DELIVERS LARGE IMPROVEMENTS IN HIP FUNCTION AND QUALITY OF LIFE: A SINGLE-CENTRE COHORT STUDY WITH 34 YEARS OF FOLLOW-UP
Authors: Lamb J. N. , Johnson R. , Siney P. , Wroblewski B. M. , Barrow J. , Divecha H. , Board T. N. 
Published: August 2024

The benefits of total hip arthroplasty (THA) may be significantly magnified in children, since the improvement in quality of life has a far greater exposure time and occurs during key developmental stages which may help to maximise lifetime achievement. The purpose of this study is to describe implant survival and patient reported outcomes (PROMS) in a cohort of children following THA.Retrospective cohort review of all patients treated with THA in a single centre. Routine data analysis did not require ethical approval.Survival was estimated using Kaplan-Meier and PROMs were recorded (EQ5D-S, Oxford hip score and modified Harris Hip Score) in a sub-group of patients.66 hips in 47 patients with a median age of 16 years (range 10 to 19 years) underwent THA between 1971 and 2023. 57% (38/68) patients were female, the commonest indications were Mucopolysaccharidoses n = 15, Stills disease (n=15), and Avascular necrosis (n=12). 27 (41%) of constructs were cemented, 5 (8%) were hybrid, and 34 (51%) were cementless. 30 stems were custom made cementless stems.Median follow up was 3.8 years (range 0–34 years). Implant survival was 87% at 10 years, 61.6% at 20 years and 52.8% at 30 years.PROMS demonstrated mean preoperative OHS was 12, preoperative MHHS was 23 and EQ5Ds VAS of 38. PROMS improved steadily overtime with mean OHS of 43, MMHS of 75 and EQ5Ds VAS of 89 at one year.THA was associated with a very large change in patient reported hip function and quality of life. In this study, THA delivered a long-lasting solution to hip pain with survival similar to that seen in patients undergoing THA in the fourth and fifth decades of life. Socioeconomic benefits of THA need further investigation to establish treatment guidelines for children suffering with hip pain.
DYSPLASTIC HIPS THAT ARE TOO LATE FOR PERIACETABULAR OSTEOTOMY ARE NOT TOO EARLY FOR TOTAL HIP ARTHROPLASTY
Authors: Treu E. A. , Sato E. H. , Omotowa O. M. , Heaton T. B. , Erickson J. A. , Blackburn B. E. , Anderson L. A. , Peters C. L. 
Published: August 2024

Total hip arthroplasty (THA) is often performed in symptomatic patients with developmental dysplasia of the hip (DDH) who do not qualify for periacetabular osteotomy (PAO). The impact of osteoarthritis (OA) severity on postoperative outcomes in DDH patients who undergo THA is not well described. We hypothesized that DDH patients who undergo THA with mild OA have slower initial recovery postoperatively, but similar one-year patient reported outcome measures (PROMs) when compared to DDH patients with severe OA.We performed a retrospective review at a single academic institution over a six-year period of patients with DDH who underwent primary THA and compared them to patients without DDH who underwent THA. Within the DDH cohort, we compared PROMs stratified by DDH severity and OA severity. Diagnosis of DDH was verified using radiographic lateral center edge angle (LCEA). Minimum one-year follow-up was required. PROMs were collected through one-year postoperatively. Logistic and linear regression models were used adjusting for age, sex, body mass index, and Charlson Comorbidity Index.263 patients with DDH were compared to 1,225 THA patients without DDH. No significant differences were found in postoperative PROMs or revision rates (p=0.49). When stratified by DDH severity, patients with LCEA<10° had worse preoperative pain (p=0.01), mental health (p<0.01) and physical function (p=0.03) scores but no significant difference in postoperative PROMs. Within the DDH group, when stratified by OA severity, patients with Grade 3 Tonnis score had worse preoperative pain (p=0.04) but no significant difference in postoperative PROMs. Recovery curves in DDH patients based upon severity of DDH and OA were not significantly different at 2-weeks, 6-weeks and 1-year.DDH patients who have mild OA have similar recovery curves compared to those with severe OA. THA is reasonable in symptomatic DDH patients who have mild arthritis and do not qualify for PAO.
TROCHANTERIC OSTEOTOMY AND TRANSFER DURING TOTAL HIP ARTHROPLASTY IN PATIENTS WITH DISLOCATED DYSPLASTIC HIPS: UNION RATE USING MONOFILAMENT TRANSVERSE WIRE CERCLAGE
Authors: Kalhor M. 
Published: August 2024

Securing the osteotomized greater trochanter (GT) during total hip arthroplasty (THA) for dislocated dysplastic hips (DDH) poses a significant challenge. This study evaluates the union rate and effectiveness of a 2-strand transverse wiring technique utilizing the lesser trochanter for wire anchorage and tensioning.A digastric anterior slide trochanteric osteotomy was performed in 106 patients (118 hips) undergoing THA for DDH. Following uncemented stem insertion, the GT was transferred and fixed to the lateral cortex of the proximal femur using monofilament stainless steel wires. In 72 out of 106 patients (80 hips), the GT was fixed with 2 transverse wire cerclages threaded through 2 drill holes in the base of the lesser trochanter, spaced vertically 5–10 millimeters apart. The wires were wrapped transversely over the GT and tightened, avoiding contact with its tendinous attachments. Patients were regularly monitored, and GT union was assessed clinically and radiographically.Patient ages ranged from 20 to 57 years (mean 35.5), with a follow-up period ranging from 1.5 to 12 years (mean 6.2). The mean union time was 3.3 months (range 2–7). Among all hips, two developed stable nonunion and single wire breakage, but no fragment displacement (2.5%). Two hips exhibited delayed union, eventually healing at 6 and 7 months after surgery.Reattachment of the greater trochanter utilizing a 2-strand transverse wire cerclage anchored at the base of the lesser trochanter demonstrated a high rate of union (97.5%) following THA in dislocated DDH cases.
TOTAL HIP ARTHROPLASTY IN PATIENTS WITH ANGULAR PROXIMAL FEMORAL DEFORMITIES
Authors: Dagneaux L. , Abdel M. P. , Sierra R. J. , Lewallen D. G. , Trousdale R. T. , Berry D. J. 
Published: August 2024

Angular proximal femoral deformities increase the technical complexity of primary total hip arthroplasties (THAs). The goals were to determine the long-term implant survivorship, risk factors, complications, and clinical outcomes of contemporary primary THAs in this difficult cohort.Our institutional total joint registry was used to identify 119 primary THAs performed in 109 patients with an angular proximal femoral deformity between 1997 and 2017. The deformity was related to previous femoral osteotomy in 85%, and developmental or metabolic disorders in 15%. 53% had a predominantly varus angular deformity. The mean age was 44 years, mean BMI was 29 kg/m2, and 59% were female. An uncemented metaphyseal fixation stem was used in 30%, an uncemented diaphyseal fixation stem in 28%, an uncemented modular body stem with metaphyseal fixation sleeve in 24%, and a cemented stem in 18%. Simultaneous corrective femoral osteotomy was performed in 18%. Kaplan-Meier survivorships and Harris hip scores were reported. Mean follow-up was 8 years.The 10-year survivorships free of femoral loosening, aseptic femoral revision, any revision, and any reoperation were 95%, 93%, 90% and 88%, respectively. Revisions occurred in 13 hips for: aseptic femoral component loosening (3), stem fracture (2), dislocation (2), aseptic acetabular loosening (2), polyethylene liner exchange (2), and infection (2). Preoperative varus angular deformities were associated with a higher risk of any revision (HR 10, p=0.03), and simultaneous osteotomies with a higher risk of any reoperation (HR 3.6, p=0.02). Mean Harris hip scores improved from 52 preoperatively to 82 at 10 years (p<0.001).In the largest series to date of primary THAs in patients with angular proximal femoral deformities, we found a good 10-year survivorship free from any revision. Varus angular deformities, particularly those treated with a simultaneous osteotomy due to the magnitude or location of the deformity, had a higher reoperation rate.Keywords: Proximal femoral deformity; dysplasia; femoral osteotomy; survivorship; revisionLevel of evidence: Level III, comparative retrospective cohort
ANATOMICAL STUDY OF PERCUTANEOUS TENOTOMY OF THE ILIOPSOAS TENDON GUIDED BY ULTRASOUND IN CADAVERS: A VIABLE TECHNIQUE?
Authors: Polesello G. C. , Ricioli W. , Gonçalves C. I. 
Published: August 2024

The objective of this study is to evaluate the effectiveness and safety of percutaneous tenotomy of the iliopsoas tendon with the aid of ultrasound in cadavers.An anatomical and descriptive study of the technique of percutaneous tenotomy of the iliopsoas tendon guided by ultrasound and to share our experience in performing it and its reproducibility in clinical practice.Out of 20 tenotomies, 17 were total, performed at the level of the superior border of the acetabulum. Three tenotomies were partial, with more than 75% of the tendon being sectioned in all three. During one of the tenotomies, there was a partial injury to the femoral nerve. Measurements were made of the distance between the site where the blade was inserted and the femoral nerve, a noble structure that would be at greater risk during the procedure, with an average distance of 8.4 millimeters.Ultrasound-guided iliopsoas tendon release procedures have the ability to be performed in a cadaveric model, consistently achieving complete tendon release, except in cases of obesity, with minimal repercussions on adjacent structures, and require approximately 4 minutes to complete.
ABDUCTOR RECONSTRUCTION WITH VASTUS LATERALIS TO GLUTEUS MEDIUS TRANSFER
Authors: Caplash G. , Caplash Y. , Copson D. , Thewlis D. , Ehrlich A. , Solomon L. B. , Ramasamy B. 
Published: August 2024

Few surgical techniques to reconstruct the abductor mechanism of the hip have been reported, with outcomes reported only from case reports and small case series from the centres that described the techniques. As in many of our revision THA patients the gluteus maximus was affected by previous repeat posterior approaches, we opted to reconstruct the abductor mechanism using a vastus lateralis to gluteus medius transfer.We report the results of such reconstructions in seven patients, mean age 66 (range, 53–77), five females, presenting with severe abductor deficiency (MRC grade 1–2). Five patients had previous revision THA, two with a proximal femoral replacement, one patient had a primary THA after a failed malunited trochanteric fracture, and one patient had a native hip with idiopathic fatty infiltration of glutei of >90%. All patients had instrumented gait analysis, and surface electromyography (EMG) of the glutei, TFL, and vastus muscles simultaneously before surgery and at each post-op follow-up. Postoperatively, patients were allowed to weight bear as tolerated and were requested to wear an abduction brace for the first six weeks after surgery to protect the transfer.All patients improved after surgery and reached an abductor power of 3 or more. All patients walked without support six months after surgery and were satisfied with the result. Abductor function continued to improve beyond one year of follow-up, and some patients reached an abductor power of 5. EMG demonstrated that the transferred vastus lateralis started firing synchronously with gluteus medius after three months post-surgery, suggesting adaptation to its new function. No knee extension weakness was recorded. One patient complained of lateral thigh numbness and was dissatisfied with the cosmetic look of her thigh after surgery.Our preliminary results are encouraging and comparable with those achieved by the originators of the technique.