Notes

Copper-Silver Nanohybrids: SARS-CoV-2 Inhibitory Areas.
SCORE II.
Modular tibial stem extensions in total knee arthroplasty (TKA) are designed to reduce the risk of aseptic loosening of the tibial base plate. However, these implants add significant cost and an evaluation of their effectiveness in reducing this risk of loosening has not been studied in a large cohort. We sought to evaluate modular tibial stem utilization in primary TKA.

We conducted a cohort study using our integrated healthcare system's Total Joint Replacement Registry. Patients who underwent cemented primary TKA were identified (2009-2019). Propensity scores were used to 11 match patients without to those with a stem extension. Cox proportional-hazards regression was used to evaluate the risk for revision due to aseptic loosening.

Ten thousand four hundred seventy six TKA with a modular tibial stem were matched to 10,476 TKA without a tibial stem. Stem utilization associated with a lower risk of revision for loosening across all postoperative follow-up (hazard ratio= 0.38, 95% confidence interval= 0.17-0.85).

In a matched cohort study, we observed presence of a stem extension was associated with a lower risk of revision for aseptic loosening. Further study to identify specific risk factors for aseptic loosening and confirm the findings presented here are warranted.

Level III.
Level III.
Lighter weight and lower modulus are potential advantages of titanium (Ti) implants over cobalt chrome (CoCr) implants in total knee arthroplasty (TKA). This study was conducted to determine whether Ti implants in TKA resulted in better clinical outcomes and radiologic results.

One hundred and eight patients (216 knees) with knee arthritis warranting bilateral primary TKA were randomly allocated to undergo Ti rotating-platform TKA in one knee and CoCr rotating-platform TKA in the contralateral knee. The mean follow-up period was 5.3 years (range, 1-7 years). The weight of Ti implants was one-third lighter than that of CoCr implants (133.9 g vs 390.1 g, P < .01). Clinical outcomes were evaluated using clinical scores, patient preferences (lightness, comfort, naturalness, and satisfaction), gait analysis (kinetic and kinematic data), range of motion, and degree of pain. Radiologic results were evaluated based on the radiolucent line (RLL), degree of medial tibial bone loss, and loosening as seen on X-ray.

No significant differences were observed in clinical scores or patient preference. Regarding implant weight, approximately 70% of patients did not perceive the Ti implant as lighter. No significant differences were observed in gait analysis, range of motion, or degree of pain. The RLL was seen in 9% of the Ti implant group and 19% of the CoCr implant group.

The lighter Ti implant did not show any clinical benefit over CoCr implants. compound 3k clinical trial The lightness of the Ti implant is not sufficient to matter or be noticeable. However, the Ti implant showed lower rate of RLL than the CoCr implant.

level I, randomized controlled trial.
level I, randomized controlled trial.
The etiology, complications, and rerevision risks of early aseptic revision total hip arthroplasty (THA) within 90 days are insufficiently documented.

A national insurance claims database (PearlDiver Technologies, Fort Wayne, IN) was queried for patients who underwent unilateral aseptic revision THA within 90 days of the index procedure using administrative codes. Patients who underwent revision for infection, without minimum 2-year follow-up, and younger than 18 years were excluded. This cohort was matched based on gender, age, and Charlson Comorbidity Index to a control group of patients who underwent primary THA without revision within 90 days. Two-year rerevision and 90-day complication rates were recorded. Chi-square and Fisher exact tests were used as appropriate for statistical comparison.

Four hundred two patients met the inclusion criteria for early aseptic revision within 90 days of the index procedure and were matched to the control group. The overall 2-year rerevision rate was higher in the early revision group compared with control group (14.9% vs 2.5%, P < .001). Complications within 90 days occurred more frequently in the early revision group, including blood transfusion (10.2% vs 3.2%, P < .001), deep vein thrombosis (9.0% vs 3.2%, P= .001), and pulmonary embolism (2.74% vs 0.75%, P= .031). The most common reasons for early aseptic revision were dislocation (41.5%), fracture (38.1%), and loosening (17.4%).

Early aseptic revision THA is associated with significantly higher 90-day complication rates and 2-year rerevision rates compared with a control group of primary THA without revision. The most common reasons for acute early revision were dislocation, fracture, and mechanical loosening.

Level III.
Level III.
Leg-length discrepancies are not commonly associated with total knee arthroplasty (TKA); however, hinge TKA is a complex form of knee reconstruction where functionality of all knee ligaments is replaced by the TKA construct. The purpose of this study is to evaluate the incidence of leg-length discrepancies after unilateral index hinge TKA and association with patient outcomes.

A retrospective review was performed of all patients who underwent unilateral index hinge TKA at a single academic institution from 1999 to 2019. Among 671 patients who underwent index hinge TKA, 188 (28%) had full-length standing anteroposterior hip-to-ankle radiographs available for review both preoperatively and postoperatively. All patients with a leg-length change ≥2 cm were also contacted with a standardized questionnaire to assess for complications. The mean age was 65 years, the mean body mass index was 33 kg/m
, and 52% were female. The mean number of prior surgeries was 2 (range, 0-12).

The absolute mean and median change in leg lengths was 20 mm and 13 mm, respectively (range, 0-130 mm). Lengthening occurred in 119 (63%) patients compared with shortening in 69 (37%) patients. An absolute change in leg lengths ≥1 cm was observed in 109 (58%) patients, ≥2 cm in 63 (34%) patients, and ≥5 cm in 15 (8%) patients.

Large changes in the leg length are common after hinge TKA, likely secondary to altered soft-tissue constraints. Surgeons should be cognizant of potential changes in the leg length in the setting of hinge TKA and incorporate this into preoperative planning and patient counseling.

Level IV, therapeutic.
Level IV, therapeutic.
Performing revision total hip arthroplasty (rTHA) for periprosthetic joint infection is complex and may require greater time and resources than aseptic revision cases. Work relative value units (RVUs) assigned may not reflect the difference in actual work required for septic revision hip cases. The purpose of this study is to compare the work effort between aseptic and septic revision hip cohorts, and determine if physicians are appropriately compensated.

Data were collected through the National Surgical Quality Improvement Program database for the years 2005 to 2018 to identify all aseptic rTHA cases and septic rTHA cases. Work RVU, operation time, RVU per minute, and dollars per minute were assessed between the aseptic and septic revision hip cohorts. link2 Univariate and multivariate analyses were used for the study.

The mean operation times for aseptic and septic rTHAs were 146.12 and 173.24minutes, respectively (P < .001). This resulted in an RVU per minute of 0.257 for the aseptic revision hip cohort compared to 0.212 for the septic cohort (P < .001). Aseptic rTHA cases were valued higher with a dollars per minute of 9.28, whereas septic rTHA cases were 7.65 (P < .001).

Although rTHA for infection is more complex and requires longer mean operative time than aseptic rTHA, physicians are not appropriately reimbursed for this challenging procedure. This inadequate RVU-based reimbursement for septic rTHA may deter physicians from performing these procedures, which could lead to decreased access to care for patients in need of rTHA for infection.
Although rTHA for infection is more complex and requires longer mean operative time than aseptic rTHA, physicians are not appropriately reimbursed for this challenging procedure. This inadequate RVU-based reimbursement for septic rTHA may deter physicians from performing these procedures, which could lead to decreased access to care for patients in need of rTHA for infection.The SARS-CoV-2 pandemic caused unprecedented disruption to primary and secondary healthcare services. Our aim was to explore whether the pandemic had had any impact on patients presenting with cervicofacial infections (CFI) of odontogenic origin to secondary care and management. Comparative analysis was carried out evaluating prospective and retrospective consecutively admitted patients with a diagnosis of CFI of odontogenic origin in the COVID-19 lockdown period from 15 March to 15 June 2020 and pre-COVID-19 during the same period of the previous year. Data included patients' demographics, comorbidities, systemic inflammatory response syndrome (SIRS) status on admission, clinical features, prior treatment in primary care, source of referral, SARS-COV-2 antigen status, treatment received in secondary care, intraoperative findings, and whether escalation of the level of care was required. Across both cohorts there were one hundred and twenty-five (125) patients admitted with CFI of odontogenic origin, with a 33% reduction (n=75 (2019) vs n=50 (2020)) in number of patients admitted during COVID-19 lockdown. There was no difference between the cohorts in terms of age (p=0.192), gender (p=0.609) or major comorbidities (p=0.654). Proportionally more patients in the COVID-19 group presented with SIRS (p=0.004). link3 This group of patients persisted with symptoms for longer before presenting to secondary care (p=0.003), more delay from hospital admission to surgical intervention (p less then 0.005) and had longer hospital stays (p=0.001). More patients required extraoral surgical drainage during COVID-19 (p=0.056). This study suggests that the COVID-19 lockdown has had adverse effects on the presentation of CFI of odontogenic origin and its management within a Regional Acute Maxillofacial Service. Commissioners and clinicians should endeavour to plan for adequate primary and secondary care provision during any future local lockdowns to ensure that patient care is optimised.Most scoring systems used to assess facial aesthetics in cleft patients tend to lack consistency, and the absence of an internationally agreed system makes comparison challenging. The most widely used and validated tool is the five-point Asher-McDade index. We note that there are currently no reports (to our knowledge) of its use for scoring outcomes after bilateral cleft lip repair. To validate it for this use, the aim was to describe the outcomes of 22 consecutive bilateral cleft lip repairs assessed using this scale. A retrospective review was undertaken of 22 consecutive patients with bilateral cleft lip repairs performed at our centre. Each patient underwent bilateral advancement rotation repair with a vomer flap on one side at three months followed by repair of the remaining hard palate and an intravelar veloplasty three months later. Standardised photographs were taken five years after repair and were cropped to isolate the nasolabial component. Eleven members of the cleft multidisciplinary team were asked to rate each image on a five-point Likert scale.
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