Revision Rates and Functional Outcomes Among Severely, Morbidly, and Super-Obese Patients Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Background: Obesity has been associated with a greater burden of symptomatic knee osteoarthritis. There is some evidence that patients with a very high body mass index (BMI) may have a higher risk of complications and poor outcomes following total knee replacement compared with non-obese patients or obese patients with a lower BMI. We hypothesized that increasing degrees of obesity would be associated with deteriorating outcomes for patients following total knee replacement.

Revision Rates and Functional Outcome Scores for Severely, Morbidly, and Super-Obese Patients Undergoing Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Background: We performed a systematic review and meta-analysis of the literature to quantify the impact of patients with severe obesity (body mass index [BMI] > 35 kg/m), those with morbid obesity (BMI > 40 kg/m), and those with super-obesity (BMI > 50 kg/m) on revision rates and outcome scores after primary total hip arthroplasty compared with non-obese patients (BMI < 25 kg/m).

Methods: Four electronic databases were reviewed (AMED, Embase, Ovid Healthstar, and MEDLINE) from their inception to August 2016. The search strategy used combined and/or truncated keywords, including hip replacement or arthroplasty and obesity, BMI, or any synonym of the latter in the title, abstract, or manuscript text.

Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Hip Arthroplasty Patients of Varying Body Mass Index Levels.

Background: The purpose of this study is to compare 90-day costs and outcomes for primary total hip arthroplasty patients between a nonobese (body mass index, 18.5-24.9) vs overweight (25-29.

Cost-Effectiveness of Total Hip Arthroplasty Versus Nonoperative Management in Normal, Overweight, Obese, Severely Obese, Morbidly Obese, and Super Obese Patients: A Markov Model.

Background: We estimated the cost-effectiveness of performing total hip arthroplasty (THA) vs nonoperative management (NM) among 6 body mass index (BMI) cohorts.

Methods: We constructed a state-transition Markov model to compare the cost utility of THA and NM in the 6 BMI groups over a 15-year period. Model parameters for transition probability (risk of revision, re-revision, and death), utility, and costs (inflation adjusted to 2017 US dollars) were estimated from the literature.

Cost-Effectiveness of Total Knee Arthroplasty vs Nonoperative Management in Normal, Overweight, Obese, Severely Obese, Morbidly Obese, and Super-Obese Patients: A Markov Model.

Background: We estimated the cost-effectiveness of performing total knee arthroplasty (TKA) vs nonoperative management (NM) among 6 body mass index (BMI) cohorts.

Methods: A Markov model was used to compare the cost-utility of TKA and NM in 6 BMI groups (nonobese [BMI 18.5-24.

Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Knee Arthroplasty Patients With Varying Body Mass Index Levels.

Background: We compared 90-day costs and outcomes for primary total knee arthroplasty patients among nonobese (body mass index [BMI] 18.5-24.9), overweight (25-29.

Post-Discharge Care Duration, Charges, and Outcomes Among Medicare Patients After Primary Total Hip and Knee Arthroplasty.

Background: In April 2016, the U.S. Centers for Medicare & Medicaid Services initiated mandatory 90-day bundled payments for total hip and knee arthroplasty for much of the country.

Inpatient Mortality and Morbidity for Dialysis-Dependent Patients Undergoing Primary Total Hip or Knee Arthroplasty.

Background: Dialysis-dependent patients can develop osteoarthritis or osteonecrosis, warranting hip or knee arthroplasty. Their comorbidities predispose them to complications. Our goal was to determine inpatient outcomes of dialysis-dependent patients after primary elective total hip or knee arthroplasty.

Perioperative blood transfusions in orthopaedic surgery.

Blood transfusion after orthopaedic surgery accounts for 10% of all packed red blood-cell transfusions, but use varies substantially across hospitals and surgeons. Transfusions can cause systemic complications, including allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, graft-versus-host disease, and infections. Tranexamic acid is a new cost-effective blood management tool to reduce blood loss and decrease the risk of transfusion after total joint arthroplasty.

Functional assessment of the acute local and distal transplantation of human neural stem cells after spinal cord injury.

Background Context: Spinal cord injury can lead to severe functional impairments secondary to axonal damage, neuronal loss, and demyelination. The injured spinal cord has limited regrowth of damaged axons. Treatment remains controversial, given inconsistent functional improvement.

Nerve mapping for prostatectomies: novel technologies under development.

Prostatic neuroanatomy is difficult to visualize intraoperatively and can be extremely variable. Damage to these nerves during prostatectomies may lead to postoperative complications such as erectile dysfunction and incontinence. This review aims to discuss the prostatic neuroanatomy, sites of potential nerve damage during a prostatectomy, and nerve-mapping technologies being developed to prevent neural injury.

Renal osteodystrophy: neurosurgical considerations and challenges.

Background: Dialysis-associated destructive spondyloarthropathy (DSA) is the major bony complication of end-stage renal disease, most commonly found in the lower cervical region. The risk factors for developing dialysis-associated DSA include duration of hemodialysis and patient age. Patients with DSA have a higher incidence of osteoporosis and poor bone mineral density, which may place them at greater risk of atraumatic fractures, instrumentation failure, and neurologic compromise.

Instrumentation of the osteoporotic spine: biomechanical and clinical considerations.

Background Context: Osteoporosis is a major health-care problem that is increasing in magnitude with the aging population. Such patients are more prone to develop painful and debilitating spinal deformities but are difficult to treat. Currently, no definitive treatment algorithm has been established.

Robotic approaches to the posterior spine.

Study Design: This anatomic study described robotic approaches to the posterior thoracolumbar spine in a porcine model. Ergonomics, control, and approach and technical difficulties were noted.

Objective: The objective of this study was to develop a robotic approach to the posterior thoracolumbar spine maximizing surgeon ergonomics and control.

Molecular genetic analysis of FGFR1 signalling reveals distinct roles of MAPK and PLCgamma1 activation for self-renewal of adult neural stem cells.

Background: Neural stem cells (NSCs) are present in the adult mammalian brain and sustain life-long adult neurogenesis in the dentate gyrus of the hippocampus. In culture, fibroblast growth factor-2 (FGF-2) is sufficient to maintain the self-renewal of adult NSCs derived from the adult rat hippocampus. The underlying signalling mechanism is not fully understood.

G9a and Jhdm2a regulate embryonic stem cell fusion-induced reprogramming of adult neural stem cells.

Somatic nuclei can be reprogrammed to pluripotency through fusion with embryonic stem cells (ESCs). The underlying mechanism is largely unknown, primarily because of a lack of effective approaches to monitor and quantitatively analyze transient, early reprogramming events. The transcription factor Oct4 is expressed specifically in pluripotent stem cells, and its reactivation from somatic cell genome constitutes a hallmark for effective reprogramming.