Risk factors associated with periprosthetic joint infection after total elbow arthroplasty.

Background: For patients undergoing total elbow arthroplasty (TEA), the present study aimed to investigate: (i) what risk factors are associated with periprosthetic elbow infection; (ii) what is the incidence of infection after TEA; and (iii) what is the acuity with which these infections present?

Methods: The Statewide Planning and Research Cooperative System database was used to identify all patients who underwent TEA between 2003 and 2012 in New York State. Admissions for prosthetic joint infection (PJI) were identified using ICD-9 (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis code 996.66.

Protocol-Driven Revision for Stiffness After Total Knee Arthroplasty Improves Motion and Clinical Outcomes.

Background: Stiffness after revision total knee arthroplasty (TKA) is a difficult problem without a well-defined treatment algorithm. The purpose of this study was to evaluate the results of revision TKA for stiffness within the context of differential component replacement.

Methods: Consecutive patients who underwent revision TKA were retrospectively identified and included those who received debridement and polyethylene liner exchange alone, revision of only one of the femoral or tibial fixed components, or revision of all components.

Intra-abdominal migration of a k-wire during revision total hip arthroplasty.

Revision total hip arthroplasty in the setting of severe acetabular bone loss is a challenging problem that is becoming more common. Kirschner wires are often used during acetabular revision for temporary fixation of trial components. We describe an intraoperative migration of a Kirschner wire through the acetabulum into the peritoneal cavity, requiring acute laparoscopic removal.

Economic evaluation of access to musculoskeletal care: the case of waiting for total knee arthroplasty.

Background: The projected demand for total knee arthroplasty is staggering. At its root, the solution involves increasing supply or decreasing demand. Other developed nations have used rationing and wait times to distribute this service.

Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft.

Background: The management of irreparable massive or full-thickness 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis remains a difficult challenge for the treating surgeon. Many different treatment options, with varied success, have been proposed.

Hypotheses: (1) Patients undergoing reconstruction of irreparable massive or full-thickness 2-tendon rotator cuff tears by dermal tissue matrix xenograft would demonstrate improvements in pain, range of motion, strength, and subjective functional outcomes.

Role of diabetes type in perioperative outcomes after hip and knee arthroplasty in the United States.

The objective of this study was to determine whether the type of diabetes mellitus (DM) affected the incidence of immediate perioperative complications following joint replacement. From 1988 to 2003, the Nationwide Inpatient Sample recognized 65,769 patients with DM who underwent total hip and knee arthroplasty in the United States. Bivariate and multivariate analyses compared patients with type 1 (n = 8728) and type 2 (n = 57,041) DM regarding common perioperative complications, mortality, and hospital course alterations.

Custom intramedullary intercalating device for treatment of supracondylar fracture between constrained total knee arthroplasty and well-fixed total hip arthroplasty.

Management of periprosthetic fractures between ipsilateral total knee arthroplasty (TKA) and total hip arthroplasty (THA) is difficult, and is further complicated in the setting of poor femoral bone stock. We present a case of supracondylar fracture between THA and long-stemmed TKA femoral components in a patient with rheumatoid arthritis, deficient metaphyseal bone stock, and recurrent fractures. A long custom intramedullary intercalating component was devised to link the well-fixed existing THA stem to a revision distal femoral component.

The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years?

Background: The Articular Surface Replacement™ (ASR™) metal-on-metal hip arthroplasty system (DePuy Orthopaedics, Inc, Warsaw, IN, USA) reportedly has a higher than anticipated early failure rate leading to a voluntary recall. This prompted us to evaluate all ASR™ components implanted at our center.

Questions/purposes: In all ASR™ components, we reported (1) revision rate, (2) blood metal ion levels, and (3) intraoperative findings for revisions related to adverse reaction to metal debris (ARMD).

Creation of a femoral cortical window to facilitate total hip arthroplasty in patients with sickle cell hemoglobinopathies.

Patients with sickle cell hemoglobinopathies often have femoral head osteonecrosis with collapse, and can benefit greatly from total hip arthroplasty. However, numerous procedural challenges and perioperative complications make these cases difficult. More specifically, femoral canal preparation and proper component placement can be particularly challenging due to focal medullary sclerosis caused by repeated vascular insults to the bone.

Total knee arthroplasty in osteopetrosis using patient-specific instrumentation.

Osteopetrosis is an uncommon endocrine disease characterized by defective osteoclast resorption of bones. This causes a hard, sclerotic, and brittle bone throughout the skeleton. Fractures and unforgiving subchondral bone are common in this condition, both of which can lead to osteoarthritis.

Dermal tissue allograft for the repair of massive irreparable rotator cuff tears.

Background: Massive irreparable rotator cuff tears in patients without advanced glenohumeral arthritis can pose a challenge to surgeons. Numerous management strategies have been utilized, and studies have shown varied results with regard to shoulder pain, range of motion, strength, and overall function.

Hypothesis: Patients undergoing repair of massive irreparable rotator cuff tears through a mini-open approach with the use of human dermal tissue matrix allograft would demonstrate an improvement in pain, range of motion, strength, and subjective functional outcomes.

ARRB1-mediated regulation of E2F target genes in nicotine-induced growth of lung tumors.

Background: Nicotine induces the proliferation of non-small cell lung cancer (NSCLC) cells via nicotinic acetylcholine receptors and the arrestin, β1 (ARRB1) protein. However, whether ARRB1 translocates to the nucleus upon nicotinic acetylcholine receptor activation and how it regulates growth of human NSCLCs are not known.

Methods: We investigated nuclear localization of ARRB1 in human NSCLC cell lines (A549 and H1650), normal lung cell lines (NHBE and SAEC), and lung cancer tissue microarray.

TRIM28 mediates primer binding site-targeted silencing of Lys1,2 tRNA-utilizing retroviruses in embryonic cells.

Murine leukemia viruses (MLVs) and related retroelements are potently restricted in embryonic cells by postintegration transcriptional silencing, likely to protect the germ line from insertional mutagenesis. This silencing is in large part attributable to the presence of a nuclear repression complex, which targets a sequence element of the proviral DNA, the repressor-binding site. The repressor-binding site closely overlaps the tRNA primer binding site, a highly conserved sequence essential for virus replication and defining the site of initiation of DNA synthesis during reverse transcription.