Notes

Geographical Differentiation associated with Hous Mali Almond Developed in various Parts of Thailand Utilizing FTIR-ATR along with NIR Spectroscopy.
Four excluded patients endorsed perceived LLD (2 mild, 2 severe), which resolved after contralateral THA.

This study noted a correlation between increasing postoperative ΔL and perceived LLD. A majority of patients (63%) experienced either improvement or full resolution of symptoms during the follow-up period. This data may have a role in reassuring the orthopedic surgeon and the patient regarding the natural course of postoperative LLD. Further investigation is needed to help identify risk factors for persistent LLD.

Level III (Prognostic).
Level III (Prognostic).
Column damage is a unique degradation pattern observed in cobalt-chromium-molybdenum (CoCrMo) femoral head taper surfaces that resemble column-like troughs in the proximal-distal direction. We investigate the metallurgical origin of this phenomenon.

Thirty-two severely damaged CoCrMo femoral head retrievals from 7 different manufacturers were investigated for the presence of column damage and chemical inhomogeneities within the alloy microstructure via metallographic evaluation of samples sectioned off from the femoral heads.

Column damage was found to affect 37.5% of the CoCrMo femoral heads in this study. All the column-damaged femoral heads exhibited chemical inhomogeneities within their microstructures, which comprised of regions enriched or depleted in molybdenum and chromium. Column damage appears as a dissolution of the entire surface with preferential corrosion along the molybdenum and chromium depleted regions.

Molybdenum and chromium depleted zones serve as initiation sites for invivo corrosion of the taper surface. Through crevice corrosion, the degradation spreads to the adjacent non-compositionally depleted areas of the alloy as well. Future improved alloy and processing recipes are required to ensure no chemical inhomogeneity due to segregation of solute elements are present in CoCrMo femoral heads.
Molybdenum and chromium depleted zones serve as initiation sites for in vivo corrosion of the taper surface. Through crevice corrosion, the degradation spreads to the adjacent non-compositionally depleted areas of the alloy as well. Future improved alloy and processing recipes are required to ensure no chemical inhomogeneity due to segregation of solute elements are present in CoCrMo femoral heads.
The purpose of this study was to investigate if there is an association between musculoskeletal health literacy with outcome and satisfaction after total knee arthroplasty (TKA).

A cross-sectional study was performed at our tertiary center to include patients between one and six years postoperatively after primary TKA. Patients were provided a survey including basic demographics, validated musculoskeletal health literacy scale (Literacy in Musculoskeletal Problems), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and TKA satisfaction (whether they would choose to undergo the same operation again). Patients were categorized as either low or normal health literacy based on number of questions (cutoff 6 out of 9) answered correctly on the Literacy in Musculoskeletal Problems. Statistical analysis included multivariate regression with significance at P < .05.

Four hundred fifty-three individuals fully completed the survey of eligible participants. Two hundred ninety-six individuals can be placed on enhancing procedure expectations and understanding to improve outcome measures and overall satisfaction.
A leukocyte esterase (LE) test is inexpensive and provides real-time information about patients suspected of periprosthetic joint infections (PJIs). The 2018 International Consensus Meeting (ICM) recommends it as a diagnostic tool with a 2+ cutoff. There is still a lack of data revealing LE utility versus the ICM 2018 criteria for PJI.

This is a retrospective study of patients who underwent revision total hip and total knee arthroplasty at a single institution between March 2009 and December 2019. All patients underwent joint aspiration before the arthrotomy, and the LE strip test was performed on aspirated joint fluid. PJI was defined using the 2018 ICM criteria.

As per the 2018 ICM criteria, 78 patients were diagnosed with chronic PJI and 181 were not infected. An LE test with a cutoff of ≥1+ had a sensitivity of 0.744, a specificity of 0.906, a positive predictive value of 0.773, an accuracy of 0.825 (95% confidence interval 0.772-0.878), and a negative predictive value of 0.891. The positive likelihood ratio (LR+) was 7.917. Using an LE cutoff of 2+ had a sensitivity of 0.513, a specificity of 1.000, and an accuracy of 0.756 (95% confidence interval-0.812).

LE is a rapid and inexpensive test which can be performed at the bedside. Its performance is valuable as per ICM criteria. Based on the findings of this study and the given cohort, we suggest using the cutoff of LE1+ (result= negative or trace) as a point of care test to exclude infection, whereas LE at 2+ threshold has near absolute specificity for the diagnosis.
LE is a rapid and inexpensive test which can be performed at the bedside. Its performance is valuable as per ICM criteria. Based on the findings of this study and the given cohort, we suggest using the cutoff of LE1+ (result = negative or trace) as a point of care test to exclude infection, whereas LE at 2 + threshold has near absolute specificity for the diagnosis.
The Centers for Medicare and Medicaid Services 2021 Physician Fee Schedule (PFS) includes increases in office reimbursement but decreases in the valuation of total hip arthroplasty and total knee arthroplasty and the conversion factor. The purpose of this study was to determine the financial impact of these changes on arthroplasty surgeons.

We queried data for 35 arthroplasty surgeons within our practice from 10/2019 to 10/2020 and captured all office and arthroplasty-related surgical procedure codes. We compared the difference in both work relative value units (RVUs) and Medicare reimbursement by surgeon based on the current 2020 PFS to the 2021 changes. We also estimated the impact of several proposals to include office increases to the global surgical package for each code.

While the mean per surgeon RVU amount for primary arthroplasty procedures will decrease (6267 vs 6,088, P= .78), the mean office work RVU (2755 vs 3,220, P= .16) will increase in 2021. However, the reduction in surgical reimbursement ($530,076 in 2020 to $464,414 in 2021) far exceeds the gains from the office ($99,456 vs $107,374), leading to an overall decrease in reimbursement ($629,532 vs $571,788), a reduction of 9%. The passage of the coronavirus disease 2019 relief bill delays many of the PFS cuts and will result in an overall reduction in reimbursement of 2.4% ($629,532 vs $612,475, P= .61).

Arthroplasty surgeons are projected to lose 2.4% of Medicare reimbursement in 2021 with the changes in the Centers for Medicare and Medicaid Services PFS. Further study is needed to determine whether these cuts will limit access to care for Medicare patients.
Arthroplasty surgeons are projected to lose 2.4% of Medicare reimbursement in 2021 with the changes in the Centers for Medicare and Medicaid Services PFS. Further study is needed to determine whether these cuts will limit access to care for Medicare patients.
The Forgotten Joint Score-12 (FJS-12) was originally developed to assess awareness of an artificial joint. VX-478 nmr Medial opening wedge high tibial osteotomy (MOWHTO), an alternative surgical method of knee replacement, is a joint-preservation surgery; therefore, joint awareness should be used to evaluate its clinical results. However, FJS-12 has not been validated as a tool to evaluate the postoperative results of MOWHTO. This study aimed to validate FJS-12 in MOWHTO.

Patients with bilateral knee surgery, previous knee surgery, flexion contracture >15°, varus alignment >20°, and patients without plate removal surgery were excluded. Finally, 71 knees of 71 patients were analyzed, with a mean follow-up of 34.5 months. The FJS-12 score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained, and the floor and ceiling effect of each score was investigated. link2 Cronbach's α was calculated to determine the internal consistency of FJS-12. link3 Spearman's correlation coefficients between FJS-12 and KOOS were calculated to assess convergent validity.

There were ceiling effects in 3 KOOS subscales (symptoms [25.4%], pain [15.5%], and activities of daily living [25.4%]) but not in FJS-12 (8.5%). No floor effect was noted in any patient-reported outcome measures. The total Cronbach's α was 0.9457 in FJS-12. FJS-12 showed moderate-to-strong positive correlations with all KOOS subscales (r= 0.64-0.72).

FJS-12 showed a lower ceiling effect than KOOS and high internal consistency and convergent validity in patients following MOWHTO. With its low ceiling effect, FJS-12 was found to be useful for evaluating patients following MOWHTO.
FJS-12 showed a lower ceiling effect than KOOS and high internal consistency and convergent validity in patients following MOWHTO. With its low ceiling effect, FJS-12 was found to be useful for evaluating patients following MOWHTO.
Metal-on-metal (MOM) surfaces in total hip arthroplasty (THA) have been used widely. Serum cobalt and chromium levels have been the standard investigation for follow-up examinations, but magnetic resonance imaging (MRI) with metal artifact reducing sequences has shown good results in detecting pseudotumors. The aim of this study is to survey a significant correlation among MRI findings, serum metal levels, and clinical scores in patients with small-head MOM implants and if serum cobalt and chromium levels are sufficient in detecting patients with pseudotumors in the long-term follow-up.

At a minimum follow-up of 20 years, 26 patients (29 THAs) of the original 98 patients (105 THAs) included in this study between November 1992 and May 1994 were available for follow-up examination. Clinical scores, serum metal ion levels, and MRIs were obtained.

We found mean serum cobalt levels of 1.87 μg/L (±3.44) and chromium levels of 2.23 μg/L (±2.96) and very good clinical and functional results (mean Harris Hip Score 88.6) in the long-term follow-up. Pseudotumors were detected in MRIs of 21 hips. There were no significant differences between patients with or without pseudotumors regarding serum metal levels and the correlation for clinical outcome scores, demographic data, and cup inclination. The cumulative rate of survival was still at 91.4% at 22.8 years.

This study presents the first published data on small-head MOM hips, comparing metal ion levels, pseudotumors, clinical, and radiological results in a follow-up period of more than 20 years and reveals that serum metal levels are not significantly higher in patients with pseudotumors.

Therapeutic Level III.
Therapeutic Level III.
Ceramic-on-ceramic bearing breakage is a rare but significant complication of total hip arthroplasty. This study aimed to identify risk factors for breakage and to determine the outcome of different revision options.

All ceramic-on-ceramic primary total hip arthroplasty procedures reported to the Australian Joint Replacement Registry from September 1999 to December 2019 were included. Procedures were subdivided into alumina or mixed ceramic (alumina/zirconia). All breakages were identified. The association between ceramic type and head size was assessed. Subsequent revision rates were compared and cause of revision assessed.

There were 23,534 alumina and 71,144 mixed ceramic procedures. Breakage was the reason for 1
revision in 84 alumina (5.27% of all revisions and 0.36% of procedures) and 56 mixed ceramic procedures (2.46% of all revisions; 0.08% of procedures). Alumina had a higher breakage rate than mixed ceramic (HR 2.50 (95% CI 1.75, 3.59), P < .001), and breakage was higher for 36-38mm head sizes using alumina (HR 2.
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