Postoperative Supine Sleeping Position Following Total Knee Arthroplasty Decreases Knee Flexion Contractures.

Background: Total knee arthroplasty (TKA) is an orthopaedic operation that improves quality of life and reduces pain in patients with disabling arthritis of the knee. One commonly recognized postoperative complication is flexion contracture of the knee. While early physical therapy and range of motion (ROM) exercises have helped improve ROM postoperatively, flexion contractures still remain a significant postoperative complication of TKA.

Interaction between time-of-day and oxytocin efficacy in mice and humans with and without gestational diabetes.

Management of labor in women with diabetes is challenging due to the high risk of peri- and postpartum complications. To avoid cesarean section and assist with labor progression, Pitocin, a synthetic oxytocin, is frequently used to induce and augment labor. However, the efficacy of Pitocin is often compromised in diabetic pregnancies, leading to increased cesarian delivery.

Fracture of an Exeter Femoral Stem With Extensive Ipsilateral Periacetabular Osteolysis.

The Stryker Exeter stem (Stryker, Kalamazoo, MI) has been in service for over 50 years and remains the most widely used cemented stem. Stem fracture is a rare complication, with recently reported rates of 1 in 10,000. We present a case of Exeter stem fracture 25 years following initial implantation as well as a large periacetabular defect secondary to osteolysis.

The Effect of Postoperative Sleeping Position on Knee Extension and Range of Motion Following Primary Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is an orthopaedic operation that improves quality of life and reduces pain in patients with disabling arthritis of the knee. One commonly recognized complication is flexion contracture of the knee. Early physical therapy helps prevent flexion contracture and improve range of motion (ROM) postoperatively.

Duodenal Ulceration Erosion Into the Common Bile Duct Status Post-Roux-en-Y Gastric Bypass: A Case Report.

Peptic ulcer disease (PUD) affects approximately four million people worldwide. The most common etiologies of PUD are  (H. pylori) infections, chronic nonsteroidal anti-inflammatory drug (NSAID) use, and smoking.

Scaphoid Nonunions Treated with Nonvascularized Bone Grafting and Screw Fixation.

 Vascularized bone grafting with screw fixation is currently considered the treatment of choice for scaphoid nonunions with avascular necrosis (AVN) of the proximal pole. A viable alternative to using vascularized bone grafts for scaphoid nonunions with AVN is nonvascularized bone grafting with screw fixation.  What are the functional outcomes of patients with scaphoid nonunions and associated proximal pole AVN who are treated with nonvascularized distal radius bone grafting and screw fixation?  Eight scaphoid nonunions with AVN, which received nonvascularized distal radius bone graft and screw fixation, underwent a retrospective review.

Transient ST-segment Elevation During Atrial Fibrillation Ablation from Septal Stretch by a Multipolar Mapping Catheter.

ST-segment elevation (STE) is a very rare complication observed during various cardiac ablation procedures. We report an interesting case of transient STE elevation by inter-atrial septal stretch during introduction of a multipolar mapping catheter during pulmonary vein isolation procedure. We also discuss various mechanisms for this observation.

A Rare Cause and Alternative Algorithm for the Treatment of Gastrointestinal (GI) Bleed: Complications of a Failed Pancreatic Transplant.

A 39-year-old woman with no known risk factors presented for a recurrent upper gastrointestinal (GI) bleed. She had a prior history of failed kidney and pancreatic transplants secondary to childhood diabetes mellitus type I. After an extensive workup, she was found to have active hemorrhage into an area of the small bowel from an artery supplying her failed pancreatic transplant.

Trends in the Use and Complications of Cardiac Resynchronization Therapy Device Implantation in Chronic Kidney Disease Patients.

Large-scale multi-hospital data on cardiac resynchronization therapy (CRT) device implantation in patients with chronic kidney disease (CKD) are currently lacking. The purpose of this study was to examine the incidence of CRT device implantation in patients hospitalized with CKD and the impact of CRT device implantation on hospital complications and outcomes. We analyzed the Nationwide Inpatient Sample from 2008-2014 to identify yearly trends in CRT device implantation during CKD hospitalizations.

His-bundle Pacing as a Bailout Therapy for a Patient with Subclavian Stenosis and No Suitable Coronary Sinus Branch: A Double Whammy.

We present an interesting case of an 88-year-old man who was referred to our arrhythmia service for an upgrade of his dual-chamber pacemaker to a biventricular pacemaker for right ventricular pacing-induced cardiomyopathy. The patient was found to have stenosis of the left subclavian vein. Here, we describe the approach used to perform venoplasty in this patient.

Efficacy of Tourniquet Use in Total Knee Arthroplasty: A Retrospective Cohort Review.

Background: The use of a tourniquet has become widely accepted as standard practice during total knee arthroplasty (TKA). There are conflicting outcomes in using a tourniquet during TKA. This brings to question the role a tourniquet has in TKA.

Failure of Screw/Shell Interface in the Trident II Acetabular System in Total Hip Arthroplasty.

We report a case series of 2 patients with screw/shell interface failure in the Stryker Trident II Acetabular System. Both failures consisted of screw penetration through the Trident II acetabular shell. One failure was observed postoperatively after a revision from a cephalomedullary nail to a total hip arthroplasty while the other was observed intraoperatively during a primary total hip arthroplasty.

The Role of High-output His-bundle Pacing During Atrioventricular Node Ablation.

Atrioventricular (AV) junction ablation (AVJA) is an acceptable strategy to control the heart rate in atrial fibrillation (AF) with a high procedural success rate. However, a small subset of patients pose a technical challenge with the standard right-sided approach. High-output His-bundle pacing has been shown to help localize the His bundle in a difficult-to-ablate AV junction.