Notes

Organic physalins through the genus Physalis: An overview.
Patients implanted with polished cobalt-chromium-cemented stems warrant monitoring with urine cobalt. Patients with cobaltemia warrant an evaluation for toxic encephalopathy.
The impact of femoral nerve blocks (FNBs) during primary total knee arthroplasty (TKA) on clinical outcomes and pain management remains unclear. The present research investigates the impact that continuous and single-shot FNBs during TKA have on postoperative opioid claims and short-term clinical outcomes.

An administrative claims database was queried to identify patients who underwent primary TKA with a continuous FNB, single-shot FNB, or no FNB. More than 300,000 patients were analyzed from the database. Rates of opioid claims were compared via achi-square analysis. Incidence of postoperative complications was compared with multivariable logistic regression.

Patients receiving a FNB had a significantly higher risk of falls both at 6 months (odds ratio [OR], 1.30) and 1 year postoperatively (OR, 1.25), as well as readmissions within 90 days (OR, 1.18) compared with patients without FNBs. The FNB cohort exhibited a higher risk of deep vein thrombosis (OR, 1.57), myocardial infarction (OR, 1.79), and cer opioid claims postoperatively than patients who received FNBs.A 53-year-old patient with a history of Loeys-Dietz syndrome (LDS) presented with cutout after a right femoral neck fracture treated with a dynamic hip screw. This was treated with conversion total hip arthroplasty (THA), the second reported THA in a patient with LDS and the first in a post-traumatic reconstruction setting. The patient had 2 episodes of posterior hip dislocations within 2 weeks after the operation requiring a revision THA utilizing dual-mobility bearing to achieve stability. LDS is a connective-tissue disorder that is associated with joint hypermobility and spinal deformities, among other features. These factors can affect hip pathology, approaches to treatment, and outcomes. Patients with LDS should have a comprehensive musculoskeletal evaluation and history such as those with Marfan syndrome or Ehlers-Danlos syndrome, especially if undergoing THA. Further research on the implications of LDS on the hip and spine should be performed.
As robot-assisted equipment is continuously being used in orthopaedic surgery, the past few decades have seen an increase in the usage of robotics for total knee arthroplasty (TKA). Thus, the purpose of the present study is to investigate the differences between robotic TKA and nonrobotic TKA on perioperative and postoperative complications and opioid consumption.

An administrative database was queried from 2010 to Q2 of 2017 for primary TKAs performed via robot-assisted surgery vs non-robot-assisted surgery. Systemic and joint complications and average morphine milligram equivalents were collected and compared with statistical analysis.

Patients in the nonrobotic TKA cohort had higher levels of prosthetic revision at 1-year after discharge (
< .05) and higher levels of manipulation under anesthesia at 90 days and 1-year after discharge (
< .05). Furthermore, those in the nonrobotic TKA cohort had increased occurrences of deep vein thrombosis, altered mental status, pulmonary embolism, anemia, acute renal failure, cerebrovascular event, pneumonia, respiratory failure, and urinary tract infection during the inpatient hospital stay (all
< .05) and at 90 days after discharge (all
< .05). All of these categories remained statistically increased at the 90-days postdischarge date, except pneumonia and stroke. Patients in the nonrobotic TKA cohort had higher levels of average morphine milligram equivalents consumption at all time periods measured (
< .001).

In the present study, the use of robotics for TKA found lower revision rates, lower incidences of manipulation under anesthesia, decreased occurrence of systemic complications, and lower opiate consumption for postoperative pain management. Future studies should look to further examine the long-term outcomes for patients undergoing robot-assisted TKA.

Level III.
Level III.The 2019 American Joint Replacement Registry shows continued growth in cases and data recorded. There are several trends noted in the registry that have been highlighted in this brief communication. More granular data collection is projected for future reports that may shed light on specific procedure and device survivorship and patient-reported outcomes. The authors encourage you to read the full report, available at the following link http//ajrr.net/publications-data/annual-reports.The proximal tibiofibular joint (PTFJ) is susceptible to osteoarthritis (OA), making it a rare but potential source of lateral knee pain. Because PTFJ OA is a rare presentation of knee pain, no first-line treatment has been established and it can be missed in evaluation before total knee arthroplasty. We report an unusual case of a 59-year-old man who presented with advanced OA of both the knee and PTFJ, along with a progressive peroneal nerve palsy due to a large compressive ganglion cyst from the PTFJ. He was treated with concurrent total knee arthroplasty, peroneal nerve decompression, and resection of the fibular head and ganglion cyst, resulting in full recovery from his arthritic pain and resolution of his peroneal neuropathy. He remains free of symptoms without instability 3 years from the index surgery.With an increasing number of joint replacements and the evolution of orthopaedic implants and hardware, there is increased occurrence and awareness of metal-related sensitivity. This has resulted in the development of devices using a variety of different materials to coat the implant. One popular option is to cover the metallic surface with a ceramic. selleck inhibitor One commercially available ceramic-coated prosthesis is coated with oxidized zirconium, with the trade name Oxinium. Although pseudotumor and metallosis resulting from ceramic joint arthroplasty implants have been documented, there is limited information on the occurrence of metallosis resulting from ceramic-coated knee implants. The purpose of this case report is to discuss a potential differential diagnosis for lower leg mass after total knee arthroplasty and to present a novel case of catastrophic failure of an Oxinium-coated total knee prosthesis (Smith and Nephew) that resulted in metallosis with extra-articular extravasation along the extensor digitorum longus tendon.
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