Notes

Tingle path expression within low-grade serous carcinoma of the ovary: surprise restorative opportunity?
Our 2-staged primary arthroplasty had a short antibiotic duration between stages, a mean of 63.5 days, and stopped within 3 days of 2
stage reducing hospital stay, morbidity, and cost.Our approach is a very viable method of treating infected DJD with a minimum drug holiday time of two weeks before implantation with a better outcome, reducing the recurrence rate of infection.Though a small number with a minimum follow-up of 24 months, we believe we provide valuable additional information.

All patients had painless return to early activities with no signs of recurrent infection. Our approach is a very viable and could serve as a cost-effective method treatment for an infected arthritic knee.
All patients had painless return to early activities with no signs of recurrent infection. Our approach is a very viable and could serve as a cost-effective method treatment for an infected arthritic knee.
We conducted a prospective study to find out change in limb length (lengthening/shortening) after total knee arthroplsty in unilateral and bilateral total knee arthroplasty (TKA) because few literature is available regarding limb length discrepancy in TKA in comparison to total hip arthroplasty. Limb length discrepancy (LLD) may lead to low back pain and gait abnormalities.

We divided 58 patients into two groups Group A (28 patients) includes patients who underwent unilateral TKA and Group B (30 patients) includes patients who underwent bilateral TKA. We assessed the patients clinico-radiologically in terms of limb length (supine position), deformity, Sagital-flexion deformity/extensor lag, coronal - varus/valgus, range of motion, knee stability, patellar tracking and Hip-knee-ankle angle preoperatively and postoperatively.

In group A, mean limb length difference (operated limb gained length as compared to unoperated limb) was 1.11cm. Out of 22 patients (78%) in whom limb length discrepancy was present,perceived LLD because in this group LLD was less than 2 cm. Limb length discrepancy may leads to dissatisfaction of the patients and poor functional outcome.Management of proximal femoral bone loss during hip arthroplasty in young patients is a complex problem due to the need to provide a joint with an increased longevity. While proximal femoral replacement (PFR) would be an easier solution, they are associated with poorer hip scores and decreased prosthesis survival rates which are not ideal while managing young patients. We present a case of proximal femoral bone loss in a young female - following multiple failed osteosynthesis surgeries aimed at addressing a pathological sub-trochanteric fracture - managed successfully with a circumferential allograft during total hip arthroplasty. While there is many literature reporting the use of circumferential allografts during revision hip surgery, this is the first case to the best of our knowledge where we are reporting its successful use in a complex primary hip arthroplasty case. Our successful outcome shows that reconstruction of proximal femoral bone loss using allografts in young patients should be considered prior to use of PFR in them.
This study tests the elution capabilities of a magnesium phosphate cement (MPC). Study objectives were to quantify the passive release of magnesium ions from MPC and to assess the effects of antibiotic-loaded MPC on bacterial growth and osteoblast viability.

MPC constructs were created and incubated in fetal bovine serum (FBS). At 2, 4, and 17 weeks, a sample was collected for magnesium ion concentration analysis. Control and vancomycin-loaded (vanc) MPC beads were also created. Zone of inhibition was measured after incubating beads on
agar plates for 24h. Osteoblasts were seeded onto control and vanc beads and cultured for 9 days. Metabolic activity was measured via a resazurin assay. ANOVA with Tukey HSD post-hoc tests and t-tests were performed.

Magnesium ions were eluted at 2 and 4-week time points without significant difference, but demonstrated a significant spike at the 17-week time point. Zones of inhibition for the bacterial species was observed for Vanc-MPC beads, but not control beads. No cytotoxic effects on osteoblasts were noted.

MPC has potential to improve bone regeneration based on its ability to passively elute magnesium. Additionally, antibiotic-loaded MPC inhibits bacterial growth while avoiding osteoblast cytotoxicity.
MPC has potential to improve bone regeneration based on its ability to passively elute magnesium. Additionally, antibiotic-loaded MPC inhibits bacterial growth while avoiding osteoblast cytotoxicity.
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly used inflammatory markers utilized to aid in the diagnosis of periprosthetic infection (PJI). Patients with obesity, however, are known to have elevated baseline levels of these inflammatory markers. Therefore, this retrospective study aimed to determine the relationship between elevated ESR and CRP and body mass index (BMI) in patients undergoing total knee arthroplasty (TKA). In doing so, physicians can better determine whether BMI should be taken into account when evaluating the prognostic value of elevated preoperative ESR and CRP levels for risk of PJI in primary TKA patients.

This is a retrospective case series of 181 patients who had undergone primary TKA at a single institution. Patients undergoing primary unilateral TKA were eligible unless they had undergone previous TKA, contralateral knee symptoms, or elevated white blood cell (WBC) count. A linear regression model was utilized to demonstrate the relationship betweeizing ESR and CRP to diagnose periprosthetic joint infection without considering BMI given that increasing preoperative levels of ESR and CRP are correlated with higher BMI.
Caution is advised when utilizing ESR and CRP to diagnose periprosthetic joint infection without considering BMI given that increasing preoperative levels of ESR and CRP are correlated with higher BMI.
Both adductor canal block (ACB) and of Local Infiltrative Analgesia (LIA) have been shown to reduce pain after total knee arthroplasty (TKA). The efficacy of combining ACB and LIA remains controversial. The objective of this study is to analyse the effect of LIA+single dose ACB compared to LIA alone on early post-operative pain and mobilization in TKA.

This Cohort Prospective study analyses the Visual Analogue Score (VAS) pain scores and rehabilitation milestones at 24h between LIA alone and LIA+single dose ACB in unilateral TKA operated by a single surgeon between August 2014 and February 2019.

VAS at rest and on movement were significantly better in the combined LIA+ACB group (n=151) compared to LIA (n=120) alone at 24h. All patients were able to achieve the desired milestones of sitting, standing by the bedside and walking with the help of a walker within 24h of the surgery.

Though the VAS scores were statistically significant, the actual scores at rest and on movement in both groups were significantly better than preoperative scores with excellent pain relief. All patients in both groups were able to ambulate within 24h. LIA alone significantly improved the pain scores and enabled early mobilization. Addition of single dose ACB to LIA did not significantly alter the milestones.
Though the VAS scores were statistically significant, the actual scores at rest and on movement in both groups were significantly better than preoperative scores with excellent pain relief. All patients in both groups were able to ambulate within 24 h. LIA alone significantly improved the pain scores and enabled early mobilization. Addition of single dose ACB to LIA did not significantly alter the milestones.
this study aims to evaluate the relationship between body mass index (BMI), age at which knee joint arthroplasty is performed and complications. The hypothesis is that the higher the BMI, the greater likelihood that the patient will require surgery at an earlier age.Methods this is a cohort study with all patients who underwent a primary knee arthroplasty, between August 2013 and February 2019, in a tertiary level university hospital. Association between BMI, age and complications were analyzed. Quality of life of patients was also evaluated with the Oxford Knee Score (OKS).

565 primary total knee replacements (TKR) were performed. A cut-off point was found in BMI of 30; 348 patients had a BMI ≤30 and 173 patients had a BMI >30. When comparing the two groups, a statistically significant difference (p=0.0186) was found in the age at which the TKR was performed. There was a significant improvement for both groups in functional score (Oxford knee score). Bay 11-7085 chemical structure Additionally, intra and post-operative complications showed no statistically significant difference.

patients with BMI greater than 30 required primary knee arthroplasty at a younger age (average 3.5 years), compared to patients with a lower BMI. Obesity does not appear to confer and independent risk for surgery in the short and mid-term. Knee arthroplasty improves significantly quality of life in the short and mid-term, regardless of their BMI, as measured with the OKS.
patients with BMI greater than 30 required primary knee arthroplasty at a younger age (average 3.5 years), compared to patients with a lower BMI. Obesity does not appear to confer and independent risk for surgery in the short and mid-term. Knee arthroplasty improves significantly quality of life in the short and mid-term, regardless of their BMI, as measured with the OKS.
The COVID-19 pandemic has impacted on the provision of elective and trauma orthopaedic surgery worldwide with millions of operations cancelled. The risk of patients developing COVID-19 after undergoing ambulatory procedures in hospitals is unknown. This paper aims to investigate the risk of developing COVID-19 from day-case and overnight stay upper limb procedures during the peak of the pandemic in London, and to discuss the implications for the safe management of elective hand and upper limb patients in the coming months.

56 patients underwent emergency trauma upper limb procedures as a day case or with a single overnight stay from 1st March to May 31, 2020at two central London hospitals that were also key players in the pan-London COVID response. Data was collected retrospectively from clinical and theatre records. Patients were contacted post-operatively and answered a structured questionnaire, including whether patients had experienced any of the symptoms suggestive of COVID-19 in the 14 days prior orons.
Venous thromboembolism (VTE), comprising either deep vein thrombosis (DVT) and pulmonary embolism (PE), is one of the most significant complications after Total Hip Arthroplasty (THA). The incidence of VTE after Direct Anterior Approach (DAA) hip arthroplasty is not known. Preceding studies have shown that internal femoral rotation used in the posterior approach leads to "scissoring" of the femoral vein and complete occlusion of flow. In contrast, external femoral rotation, utilized in an anterior approach, does not lead to any limitation in venous flow. We hypothesize that the rate of VTE post-operatively after DAA THA is comparable, if not lower, to other conventional approaches.

Retrospective analysis of medical records was examined to identify the incidence of symptomatic DVT within 6 months post-surgery, yielding 196 cases of elective primary DAA after THAs between 2015 and 2019. Aspirin was administered post-operatively. Corresponding imaging was performed for cases with high clinical suspicion of either DVT or PE based on Well's criteria.
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