Rate and Timing of Progression to Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction in Patients With Systemic Inflammatory Disease: A Long-term Propensity-Matched Cohort Study.

Background: Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopaedic procedures and one of the most well studied. Despite extensive research dedicated to ACLR, there is limited understanding of how chronic inflammatory systemic diseases (CIDs) such as rheumatoid arthritis and systemic lupus erythematosus affect outcomes.

Purpose: To compare the outcomes of ACLR in cohorts of patients with and without CID.

Kenneth Keown (1917-1985): Innovator in Early Cardiac Anesthesiology.

Kenneth Keown, MD, was a forward-thinking anesthesiologist who developed techniques to allow the safe practice of cardiac anesthesia and opened the door for the future development of more complex intracardiac surgical procedures. His early successful protocols for cardiac anesthesiology and his wide-reaching education of others on these methods earned him the designation of "the grand old man of anesthesia for inside-the-heart surgery" at a young age. His contributions also extended to groundbreaking research in hypothermia, lidocaine uses as an antiarrhythmic, and advocacy for anesthesiology as a specialty.

Obesity and Anesthesia: Challenges in the Perioperative Period.

The obesity epidemic has significant implications for all aspects of healthcare. The physiological changes of obesity affect every area of perioperative medicine. In this article, we discuss several anesthetic concerns regarding obesity.

Machine learning can accurately predict risk factors for all-cause reoperation after ACLR: creating a clinical tool to improve patient counseling and outcomes.

Purpose: Identifying predictive factors for all-cause reoperation after anterior cruciate ligament reconstruction could inform clinical decision making and improve risk mitigation. The primary purposes of this study are to (1) determine the incidence of all-cause reoperation after anterior cruciate ligament reconstruction, (2) identify predictors of reoperation after anterior cruciate ligament reconstruction using machine learning methodology, and (3) compare the predictive capacity of the machine learning methods to that of traditional logistic regression.

Methods: A longitudinal geographical database was utilized to identify patients with a diagnosis of new anterior cruciate ligament injury.

A Deep Learning Tool for Automated Landmark Annotation on Hip and Pelvis Radiographs.

Background: Automatic methods for labeling and segmenting pelvis structures can improve the efficiency of clinical and research workflows and reduce the variability introduced with manual labeling. The purpose of this study was to develop a single deep learning model to annotate certain anatomical structures and landmarks on antero-posterior (AP) pelvis radiographs.

Methods: A total of 1,100 AP pelvis radiographs were manually annotated by 3 reviewers.

Frank Stinchfield Award: Creation of a Patient-Specific Total Hip Arthroplasty Periprosthetic Fracture Risk Calculator.

Background: Many risk factors have been described for periprosthetic femur fracture (PPFFx) following total hip arthroplasty (THA), yet a patient-specific risk assessment tool remains elusive. The purpose of this study was to develop a high-dimensional, patient-specific risk-stratification nomogram that allows dynamic risk modification based on operative decisions.

Methods: We evaluated 16,696 primary nononcologic THAs performed between 1998 and 2018.

Patient-specific Hip Arthroplasty Dislocation Risk Calculator: An Explainable Multimodal Machine Learning-based Approach.

Purpose: To develop a multimodal machine learning-based pipeline to predict patient-specific risk of dislocation following primary total hip arthroplasty (THA).

Materials And Methods: This study retrospectively evaluated 17 073 patients who underwent primary THA between 1998 and 2018. A test set of 1718 patients was held out.

Shoulder arthroplasty after prior external beam radiation therapy: a matched cohort analysis.

Background: External beam radiation therapy (XRT) is a commonly used therapeutic modality for the treatment of various chest wall and axillary malignancies. Despite the known risk of local soft tissue dysfunction, and possibly compromised bone ingrowth for cementless implants, there remains limited data on the impact of prior XRT in a shoulder arthroplasty (SA) cohort. This study evaluated the outcomes of primary SA in patients with prior XRT compared to a matched cohort (MC).

Applying Deep Learning to Establish a Total Hip Arthroplasty Radiography Registry: A Stepwise Approach.

Background: Establishing imaging registries for large patient cohorts is challenging because manual labeling is tedious and relying solely on DICOM (digital imaging and communications in medicine) metadata can result in errors. We endeavored to establish an automated hip and pelvic radiography registry of total hip arthroplasty (THA) patients by utilizing deep-learning pipelines. The aims of the study were (1) to utilize these automated pipelines to identify all pelvic and hip radiographs with appropriate annotation of laterality and presence or absence of implants, and (2) to automatically measure acetabular component inclination and version for THA images.

Cost comparison and complication profiles of superior capsular reconstruction, lower trapezius transfer, and reverse shoulder arthroplasty for irreparable rotator cuff tears.

Background: Irreparable rotator cuff tears (IRCTs) pose treatment challenges both clinically and financially. As cost-effectiveness initiatives are prioritized, value-based health care delivery models are becoming increasingly common. The purpose of this study was to perform a comprehensive analysis of the cost, complications, and readmission rates of 3 common surgical treatment options for IRCTs: superior capsular reconstruction (SCR), arthroscopically assisted lower trapezius tendon transfer (LTTT), and reverse shoulder arthroplasty (RSA).

Isomeric Carborane Neuromuscular Blocking Agents.

We synthesized a family of neuromuscular blocking agents (NMB) based on decamethonium, but containing a carborane cluster in the methylene chain between the two quaternary ammonium groups. The carborane cluster isomers o-NMB, m-NMB, and p-NMB were tested in animals for neuromuscular block and compared with agents used clinically: rocuronium and decamethonium. All three isomers caused reversible muscle weakness in mice as determined by grip strength and inverted screen tests, with a potency rank of p-NMB > rocuronium > decamethonium > m-NMB > o-NMB.

Opiate Analgesics and the Perioperative Management of Patients with Obstructive Sleep Apnea.

As the rate of obesity and subsequently obstructive sleep apnea (OSA) continue to rise in North America and prescriptions for narcotic analgesics number in the tens of millions, it has become increasingly important to understand the interaction between OSA and opiate analgesics. Understanding the mechanism of action of opiate analgesics and the pathophysiology of OSA can help medical professionals understand the unique risks associated with pain management in this population of patients.

Pain management in the geriatric population.

Pain is a highly prevalent and clinically important problem in the elderly. Unfortunately, due to difficulties in assessing pain in geriatric patients, the complexities of multiple comorbidities, and the high prevalence of polypharmacy, many practitioners are reluctant to treat pain aggressively in this unique patient population. Safe and effective treatment therefore, requires a working knowledge of the physiologic changes associated with aging, the challenges of accurately assessing pain, the unique effects of common therapeutic agents upon the elderly as well as the importance of adjunctive therapies.

Pain management mini-series part III. Procedural sedation for the non-anesthesia provider.

Diagnostic and therapeutic procedures performed outside of the operating room can necessitate the administration of sedation by non-anesthesia trained personnel. Risks associated with procedural sedation can be decreased through proper patient evaluation and selection. Understanding sedative pharmacology, dosing and delivery, monitoring and airway rescue techniques are essential to safely provide sedation.

Pain management mini-series. Part II. Chronic opioid drug therapy: implications for perioperative anesthesia and pain management.

In the U.S., there is a growing percentage of chronic pain patients requiring surgery.

Pain management mini-series. Part I. A review of management of acute pain.

Acute pain is a complex process involving activation of nociceptors, chemical mediators and inflammation. Medications can be used to target each of the key elements within the pain pathway and eliminate or reduce the sensation of pain. Pain management begins, when possible, prior to the tissue trauma and continues throughout the perioperative period.