Active surveillance selection and 3-year durability in intermediate-risk prostate cancer following genomic testing.

Background: Genomic testing can add risk stratification information to clinicopathological features in prostate cancer, aiding in shared medical decision-making between the clinician and patient regarding whether active surveillance (AS) or definitive treatment (DT) is most appropriate. Here we examined initial AS selection and 3-year AS durability in patients diagnosed with localized intermediate-risk prostate cancer who underwent Prolaris testing before treatment decision-making.

Methods: This retrospective observational cohort study included 3208 patients from 10 study sites who underwent Prolaris testing at diagnosis from September 2015 to December 2018.

Early outcomes of primary total hip arthroplasty with use of a smartphone-based care platform: a prospective randomized controlled trial.

Aims: The purpose of this study is to evaluate early outcomes with the use of a smartphone-based exercise and educational care management system after total hip arthroplasty (THA) and demonstrate decreased use of in-person physiotherapy (PT).

Methods: A multicentre, prospective randomized controlled trial was conducted to evaluate a smartphone-based care platform for primary THA. Patients randomized to the control group (198) received the institution's standard of care.

Are Postoperative Laboratory Studies Following Robotic Assisted Radical Prostatectomy Necessary?

Introduction: We evaluated the necessity of obtaining routine postoperative laboratory studies, such as complete blood count and basic metabolic panel, after robotic assisted radical prostatectomy.

Methods: This study is a retrospective review of 200 robotic assisted radical prostatectomy cases performed over a year and a half at our institution. The incidences of laboratory abnormalities were examined along with any clinical intervention.

Multiple Cultures and Extended Incubation for Upper Extremity Revision Arthroplasty Affect Clinical Care: A Cohort Study.

Unlabelled: Skin flora organisms (SFOs) isolated from 1 to 2 tissue samples during shoulder and elbow revision arthroplasty are difficult to distinguish as contamination or infection. We examined the change in clinical care after implementation of an Arthroplasty Infection Protocol by increasing the number of intraoperative samples held for 10-day incubation to a minimum of 5.

Methods: Infection was defined as ≥3 cultures growing the same SFO or any one culture growing any other virulent organism.

Which Objective Parameters Are Associated with a Positive Urine Culture in the Setting of Ureteral Calculi: The Ureteral Calculi Urinary Culture Calculator.

Objective: To determine associations between laboratory values and subsequent culture positivity in the acute ureteral calculi patient. Specifically, we aim to develop a predictive model to assist with optimization of patient outcomes and improvement of antimicrobial stewardship.

Methods: Utilizing the electronic medical record system, we conducted a retrospective review of 3888 patients with ureteral calculi.

Bezoars in Adults: Determining Optimal Management.

Fungal bezoars, or fungal balls, are rare pathologic consequences of funguria in immunocompromised patients. Current treatment recommendations are based on expert opinion and low level evidence. We present a case of a bezoar that was effectively treated with percutaneous amphotericin B instillations.

Tibial Tubercle Osteotomy to Aid Exposure for Revision Total Knee Arthroplasty.

Introduction: A tibial tubercle osteotomy can provide reliable and safe exposure during revision total knee arthroplasty with a high union rate, low complication rate, and predictable outcomes.

Step 1 Preoperative Planning Figs 1-a Through 2-b: Determine the need for an extensile approach on the basis of the preoperative knee range of motion; position of the patella; bone quality; medical comorbidities; and cement mantle, tibial keel or stem, and thickness of the anterior tibial cortex.

Step 2 Incision And Arthrotomy: Create full-thickness subcutaneous flaps and perform a medial parapatellar arthrotomy with complete synovectomy and careful excision of scar tissue from the medial and lateral gutters.

Staged total hip arthroplasty in a patient with hip dysplasia and a large pertrochanteric bone cyst.

Hip arthroplasty in young patients requires thoughtful preoperative planning. Patients with proximal femoral bone loss complicate this planning and may require a staged procedure to optimize implant insertion. We report on a case of a 26-year-old woman with secondary hip arthritis from developmental dysplasia of the hip and a large pertrochanteric bone cyst that was treated with staged total hip arthroplasty.

Patient-specific versus conventional instrumentation for total knee arthroplasty: peri-operative and cost differences.

The role of patient-specific instrumentation in total knee arthroplasty (TKA) is yet to be clearly defined. Current evidence evaluating peri-operative and cost differences against conventional TKA is unclear. We reviewed 356 TKAs between July 2008 and April 2013; 306 TKAs used patient-specific instrumentation while 50 had conventional instrumentation.

Salvage hip arthroplasty after failed fixation of proximal femur fractures.

We reviewed 46 patients who underwent salvage hip arthroplasty (SHA) for revision of failed cannulated screws (CS), sliding hip screws (SHS), or intramedullary nails (IMN). The primary objective was to determine differences in operative difficulty. SHA after failed femoral neck fixation was associated with lower intra-operative demands than after failed peri-trochanteric fractures.

Reconstruction of a bony bankart lesion: best fit based on radius of curvature.

Background: The inferior coracoid process has traditionally been considered to be the gold standard for glenoid augmentation after anteroinferior bone loss. Other autograft sites, and more recently, osteochondral allograft sites, have been described as potential donor sources.

Purpose: Potential autograft and osteochondral allograft sites were compared to identify the graft source that would provide the best fit for glenoid augmentation.

Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review.

Background: The advantage of single-row versus double-row arthroscopic rotator cuff repair techniques has been a controversial issue in sports medicine and shoulder surgery. There is biomechanical evidence that double-row techniques are superior to single-row techniques; however, there is no clinical evidence that the double-row technique provides an improved functional outcome.

Hypothesis: When compared with single-row rotator cuff repair, double-row fixation, although biomechanically superior, has no clinical benefit with respect to retear rate or improved functional outcome.

Validation of a high fidelity adult ureteroscopy and renoscopy simulator.

Purpose: Surgical simulation technology may efficiently train and accurately assess the acquisition of many skills. Surgical simulators often lack realism and can be expensive at $3,000 to more than $60,000. We assessed the face, content and construct validity of a newly developed, anatomically accurate, reasonably priced high fidelity ureteroscopy and renoscopy trainer.

Postoperative hemorrhage following robotic-assisted laparoscopic prostatectomy controlled with external penile compression.

We report a postoperative hemorrhage of the dorsal vein complex after transperitoneal robotic-assisted laparoscopic prostatectomy managed with external penile compression. Control of the dorsal vein required two sutures, and the estimated blood loss due to the procedure was 400 ml. Severe gross hematuria developed on postoperative day 2, but this quickly subsided with external compression at the base of the penis.