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Anatomic total shoulder arthroplasty (TSA) is a common surgical intervention for various shoulder pathologies, predominantly glenohumeral osteoarthritis. While generally considered safe and effective, complications remain a challenge. Short stem implants, aim to preserve bone stock and reduce complications. However, concerns about a specific short stem implant (Univers Apex; Arthrex, Naples, FL, USA) have surfaced due to high reported rates relatively early aseptic loosening. This retrospective study analyzed 116 consecutive TSA patients with Univers Apex implants from 2004 to 2022. Fifteen revision cases were assessed for radiographic loosening and explanted implants were examined for damage using a 0-3 scale. Histopathological analysis evaluated cellular responses to wear debris. Of the patients, 13% (15/116) required revision at 23.2 months on average. A distinct radiographic loosening pattern was identified, with humeral component subsidence and thinning of the proximal humeral cortex. Histopathology revealed a robust inflammatory response to wear debris, with a potential association between macrophage infiltration, hinge damage, and polyethylene wear. This study reveals a notable rate of early aseptic humeral loosening with the Univers Apex short stem implant, emphasizing concerns raised in previous reports and providing a potential explanation for the high rate of early failure. Surgeons should exercise caution and closely monitor patients with this implant design. [ABSTRACT FROM AUTHOR]

Introduction: In comparison to primary TKA, outcomes of revision TKA will always appear inferior. When trying to assess outcomes of revision TKA for PJI, a group of aseptic revisions can serve as a reliable control, as compared to primary TKA. Our primary aim was to compare functional outcomes of septic versus aseptic revisions by using 5 scoring systems. Materials and methods: We retrospectively reviewed 45 revision knee arthroplasty cases. Of the 45 cases, 17 belonged to the septic group and 28 to the aseptic group. The scores obtained were assessed for differences between the two groups using the Mann-Whitney U test. Pearson correlation coefficient (r) was calculated to assess the correlation between the PCS and MCS of the SF-36 score vs. other scores. Results: The mean WOMAC score in the septic group was 38.88 ± 6.35 and in the aseptic group was 44.96 ± 10.07. With regards to the SF-36 score, the RE component (role limitations due to emotional problems) showed a significant difference, being poorer in the septic group (51.06 ± 31.57) as compared to the aseptic group (69.18 ± 28.62). We found a higher incidence of rest pain and nocturnal pain in the septic group. None of the scoring systems showed correlation with the SF-36 score. Conclusion: In our study, there was a significant difference in the outcome of revision TKA based on etiology only with regards to the WOMAC score. Moreover, our study brings to the fore the importance of not just surgical management of patients with septic failure but also the importance of paying heed to the emotional and social problems encountered by these patients which has an impact on their outcome as a whole and diminishes their perception of benefit from revision surgery in spite of equivocal knee scores as compared to their counterparts. [ABSTRACT FROM AUTHOR]

Mutations in the complement factor I (CFI) gene have previously been identified as causes of recurrent CNS inflammation. We present a case of a 26-year-old man with 18 episodes of recurrent meningitis, who had a variant in CFI(c.859G>A,p.Gly287Arg) not previously associated with neurologic manifestations. He achieved remission with canakinumab, a human monoclonal antibody targeted at interleukin-1 beta.

Background: Non‐septic tenosynovitis is a clinically relevant and often performance limiting musculoskeletal injury in the horse. Objectives: To review the published literature to determine which tendon sheaths are commonly affected by non‐septic tenosynovitis and to describe the most frequently reported pathological lesions, outcomes, and surgical complications in equine non‐septic tenosynovitis. Study design: Systematic review. Methods: Literature searches were conducted in July 2021 from the online search engines PubMed, Scopus, Web of Science Core, VetMed Resource and ProQuest Theses & Dissertations. The inclusion criteria followed a participants, interventions, comparisons, outcome and study design (PICOS) approach. For inclusion, studies had to include live equids with non‐septic tenosynovitis of any tendon sheath. Studies were excluded if they only described non‐equine species, if they included data only on non‐tendon sheath structures, or if they included data exclusively on cases of septic or contaminated tendon sheaths. Determination of non‐sepsis relied on the diagnosis of the original authors; however, if non‐sepsis was not explicitly specified, then cases that had a history of contamination of the sheath, a wound near the sheath or a positive bacterial culture were excluded from analysis. Data analysed included the distribution of structures affected by non‐septic tenosynovitis, the most common pathological lesions identified within each sheath, and the most frequently reported surgical complications of non‐septic tenosynovitis. The quality of each study was assessed using a methodological quality analysis. Results: A total of 85 studies describing non‐septic tenosynovitis in the horse were included. Across all 85 studies, there were a total of 2449 tendon sheaths in 2101 horses reported to be affected by non‐septic tenosynovitis. The digital flexor sheath was the most reported structure to be diagnosed with non‐septic tenosynovitis: 41/85 (48%) studies examined the digital flexor sheath exclusively, followed by the carpal flexor sheath, tarsal flexor sheath, carpal extensor sheaths, tarsal extensor sheaths, and one case of biceps brachii non‐septic tenosynovitis. For most tendon sheaths, the most common pathological lesion was an intrathecal tear of a soft tissue structure, including tears of the deep digital flexor tendon and tears of the manica flexoria. Bilateral disease was most common in the carpal flexor sheath, where distal radial physeal exostoses were the most common pathological lesions. Less common causes of non‐septic tenosynovitis included neoplasia, fracture of a bone adjacent to a tendon sheath, and mineralisation of an intrathecal tendon. The likelihood of return to previous level of athletic function following non‐septic tenosynovitis of most structures was approximately 50%, and the most common complication was persistent effusion following tenoscopy. While iatrogenic infection following surgery was uncommon, it was most likely following tenoscopy of the digital flexor sheath. Conclusion: Non‐septic tenosynovitis is commonly reported in equine athletes, with intra‐thecal tears of the deep digital flexor tendon, superficial digital flexor tendon and manica flexoria frequently reported. Directions for future research include more thorough assessment of and reporting of complications following non‐septic tenosynovitis and correlation of characteristics of intrathecal pathological lesions with clinical outcomes. [ABSTRACT FROM AUTHOR]

Aseptic revisions are the most common reason for revision total knee arthroplasty (rTKA). Previous literature reports early periprosthetic joint infection (PJI) rates after aseptic rTKA to range from 3 to 9.4%. Intraosseous (IO) regional administration of vancomycin has previously been shown to produce high local tissue concentrations in primary and rTKA. However, no data exist on the effect of prophylactic IO vancomycin on early PJI rates in the setting of aseptic rTKA. The aim of this study was to determine the following: (1) what is the rate of early PJI during the first year after surgery in aseptic rTKA performed with IO vancomycin; and (2) how does this compare to previously published PJI rates after rTKA. A consecutive series of 117 cases were included in this study who underwent rTKA between January 2016 and March 2022 by 1 of 2 fellowship-trained adult reconstruction surgeons and received IO vancomycin at the time of surgery in addition to standard intravenous antibiotic prophylaxis. Rates of PJI at 3 months, 1 year, and the final follow-up were evaluated and compared to prior literature. Follow-up at 3 months was available for 116 of the 117 rTKAs, with 1 lost to follow-up. The rate of PJI was 0% at 3 months postoperatively. Follow-up at 1 year was obtained for 113 of the 117 rTKAs, and the PJI rate remained 0%. The rate of PJI at the final follow-up of ≥ 1 year was 0.88% (95% confidence interval: −0.84 to 2.61). Previous literature reports PJI rates in aseptic rTKA to range from 3 to 9.4%. Dual prophylactic antibiotics with IO vancomycin in conjunction with intravenous cephalosporins or clindamycin were associated with a substantial reduction in early PJI compared to prior published literature. These data supplement the early evidence about the potential clinical benefits of IO vancomycin for infection prevention in high-risk cases. Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Revision shoulder arthroplasty (SA) is a surgical procedure performed to address complications or failures of primary total SA. However, limited evidence exists regarding the functional outcomes and longevity of implants following revision. A retrospective analysis was conducted on patients who underwent revision SA for failed primary arthroplasty at a single institution between 2009 and 2021 with a minimum of 2-years follow-up. Data was collected from medical records, including type of arthroplasty (anatomic total SA [TSA], reverse total SA [RSA], or hemi-SA [HSA]), demographics and patient-specific information, functional measurements, and implant survival. Patient reported outcomes were obtained during follow-up by phone. The mean age at index and revision surgeries was 60.5 ± 12.1 years and 64.8 ± 11.1 years, respectively, and average total follow-up was 5.5 ± 3.5 years. The average time to revision was 4.5 ± 5.2 years (range 0.01–24.5 years). Among 99 revision shoulder arthroplasty procedures, 28 were TSA/HA to TSA/HA, 51 were TSA/HA to RSA, 18 were RSA to RSA, and 2 were RSA to HA. Revision surgery significantly improved functional outcomes in forward elevation (preoperative: 79.8 ± 41.0 vs postoperative: 118.5 ± 38.3; p < 0.001), external rotation (preoperative: 27.8 ± 19.3 vs postoperative: 34.3 ± 16.2; p = 0.028), internal rotation (preoperative: glute vs postoperative: S1; p = 0.002), and forward elevation strength (preoperative: 4+/5 vs postoperative: 5/5; p = 0.002). Postoperative patient reported outcomes included: VAS pain (2.2 ± 2.9), SANE (72.6 ± 21.5), ASES (73.3 ± 20.4), and SST (7.7 ± 2.8) scores. The overall 2-, 5-, and 10-year post-revision implant survival rate was 85.48%, 83.06%, and 79.84%, respectively. Patients who had an initial RSA and were revised to RSA were at higher risk of implant failure and subsequent re-revision (RSA to RSA: 1.5 ± 2.5 years vs. TSA/HA to RSA: 2.5 ± 2.1 years vs. TSA/HA to TSA/HA: 4.0 ± 3.5 years; p = 0.0046) Revision shoulder arthroplasty improved patient outcomes post-index arthroplasty failure. Revisions were more likely to be successful when revising from TSA/HA to RSA. Level III – retrospective comparative study. [ABSTRACT FROM AUTHOR]

Although frequently prescribed, certain antibiotics such as trimethoprim-sulfamethoxazole carry the risk of a rare yet life-threatening adverse effect, termed drug-induced aseptic meningitis. Morbidity can be avoided if the medication is identified and discontinued. Patients in reported cases tend to be female and have an autoimmune disease or prior adverse reaction to the offending agent. As a rare and poorly characterized condition, the subset of patients using antibiotics at risk for aseptic meningitis remains unclear; hence, cataloging these adverse events remains critical for better elucidating the disease. Here, we report a 62-year-old man with psoriasis and no prior history of sulfa allergy, who presented with a sudden onset of fever, chills, vomiting, and muscle aches 5 hours after taking single doses of trimethoprim-sulfamethoxazole and ciprofloxacin. Common infectious causes were ruled out, and his medications were discontinued. Despite initial symptom resolution with discontinuation, the patient neurologically deteriorated over the next two days before eventually recovering with supportive care. This case highlights the variable presentation of drug-induced aseptic meningitis. In contrast to previous reports of drug-induced aseptic meningitis, our patient was male, older than the median age of 40 years, and did not have a prior adverse reaction to the antibiotic. Furthermore, to the best of our knowledge, we report a possible case of antibiotic-induced aseptic meningitis in a patient with psoriasis. Lastly, the case emphasizes not only the value of a thorough medication history but also the importance of recognizing that patients may deteriorate in the first 48 hours before resolution.

Relapsing polychondritis (RP) is a rare and, if not treated, potentially lethal autoimmune disorder. Involvement of central nervous system (CNS) in RP is rare and, when present, makes it extremely difficult to diagnose. In this report, we present a case of a 22-year-old Hispanic woman who presented with sudden onset of headache and blurred vision. Magnetic resonance imaging (MRI) of her brain and orbit showed leptomeningeal enhancements in addition to asymmetrical thickening and enhancement of globes. Her lumbar puncture was consistent with aseptic meningitis picture, and she was placed on empirical treatment for presumptive CNS tuberculosis. Her vision deteriorated, and she was diagnosed with RP with CNS and ocular involvement and placed on high-dose steroids with dramatic rapid response. She has been on immunosuppressive treatment, including Sulfasalazine and Methotrexate, since then and her disease has been under control with decreased need for ophthalmic steroid drops. There have been only 19 previous cases found in literature reporting an association of RP with CNS involvement.

While the cause of altered mentation in the elderly may be multifactorial, infectious etiologies may be missed. This case report aims to detail an account of a patient with dementia, found to have Lyme meningitis in the setting of a normal pressure hydrocephalus (NPH). The patient smelled of urine and presented with ambulatory dysfunction, fitting the "wet, wacky, and wobbly" triad of NPH while also having subjective chills and leukocytosis. Non-contrast brain CT scan showed dilated ventricles. Cerebrospinal fluid (CSF) studies suggested aseptic meningitis. Serum studies using a modified twotiered algorithm confirmed the diagnosis of Lyme disease. Treatment of the underlying condition with a prolonged course of doxycycline improved symptoms and clinical course. Review of the literature on the association between Lyme meningitis and NPH reveals that few cases of Lyme-related NPH have been reported worldwide and further research into the pathophysiology, diagnostic approach, treatment modalities, and management of NPH secondary to Lyme meningitis may be warranted. [ABSTRACT FROM AUTHOR]

BackgroundIntravenous catheter (IVC) use in hospitalized ruminants is a common procedure. Limited information is available describing complications associated with IVCs.HypothesesPrevalence of IVC infections in hospitalized ruminants is >50%. Intravenous catheters maintained for >5 days are more likely to be infected than those maintained for 4 days had a higher likelihood of being infected than those maintained for 4 days to reduce IVC infection.

Metagenomic next-generation sequencing (mNGS) for pan-pathogen detection has been successfully tested in proof-of-concept case studies in patients with acute illness of unknown etiology but to date has been largely confined to research settings. Here, we developed and validated a clinical mNGS assay for diagnosis of infectious causes of meningitis and encephalitis from cerebrospinal fluid (CSF) in a licensed microbiology laboratory. A customized bioinformatics pipeline, SURPI+, was developed to rapidly analyze mNGS data, generate an automated summary of detected pathogens, and provide a graphical user interface for evaluating and interpreting results. We established quality metrics, threshold values, and limits of detection of 0.2-313 genomic copies or colony forming units per milliliter for each representative organism type. Gross hemolysis and excess host nucleic acid reduced assay sensitivity; however, spiked phages used as internal controls were reliable indicators of sensitivity loss. Diagnostic test accuracy was evaluated by blinded mNGS testing of 95 patient samples, revealing 73% sensitivity and 99% specificity compared to original clinical test results, and 81% positive percent agreement and 99% negative percent agreement after discrepancy analysis. Subsequent mNGS challenge testing of 20 positive CSF samples prospectively collected from a cohort of pediatric patients hospitalized with meningitis, encephalitis, and/or myelitis showed 92% sensitivity and 96% specificity relative to conventional microbiological testing of CSF in identifying the causative pathogen. These results demonstrate the analytic performance of a laboratory-validated mNGS assay for pan-pathogen detection, to be used clinically for diagnosis of neurological infections from CSF.

Graphical abstract According to the recommendations by the World Health Organization, the insertion of a peripheral venous catheter (PVC) must be an aseptic procedure while using non-sterile gloves. To overcome this apparent contradiction we have invented and patented (WO/2021/123482) a new device to be used during PVC insertion. The device permits the PVC placement in the vein while avoiding to directly touch the catheter with the fingertips. A total of 16 PVCs were inserted in the veins of a venipuncture anatomic training model while the operator was wearing non-sterile gloves. The gloves had been previously contaminated by embedding the fingertips in an agar plate inoculated with Staphylococcus epidermidis. Following insertion, the PVCs were sterilely removed and deposited on a bacterial culture plate. The tip cultures of PVCs that had been inserted with or without the use of the device were compared. Eight out of eight cultures (100.0%) were positive for S. epidermidis when the PVC had been inserted without using the device, whereas only one out of eight (12.5%) was positive when the device had been used. The single positive tip culture in the latter group corresponded to an insertion in which the operator had inadvertently touched the sterile part of the device while manipulating it. In conclusion, an auxiliary novel device allows the aseptic insertion of PVCs while the operator is wearing non-sterile gloves. Regulatory institutions should consider to recommend the insertion of PVCs by means of devices aimed at avoiding the contamination of the catheter. [ABSTRACT FROM AUTHOR]

Radiographic osteolysis after total shoulder arthroplasty (TSA) remains a challenging clinical entity, as it may not initially manifest clinically apparent symptoms but can lead to clinically important complications, such as aseptic loosening. A thorough consideration of medical history and physical examination is essential to rule out other causes of symptomatic TSA—namely, periprosthetic joint infection—as symptoms often progress to vague pain or discomfort due to subtle component loosening. Once confirmed, nonoperative treatment of osteolysis should first be pursued given the potential to avoid surgery-associated risks. If needed, the current surgical options include glenoid polyethylene revision and conversion to reverse shoulder arthroplasty. The current article provides a comprehensive review of the evaluation and management of osteolysis after TSA through an evidence-based discussion of current concepts.

Background: Aseptic loosening of the cemented tibial component is a source of failure in total knee arthroplasty. This study examined common techniques for cement application by quantifying depth and volume of penetration into tibia models. Material and methods: Thirty-six composite tibia models were cemented with a tibial component using 3 application techniques (gun, osteotome, and layered) with either early or late cement working time. Computed tomography and 3D-modeling were used to quantify volume and depth of penetration. Statistical analysis was conducted with analysis of variance with Bonferroni correction and Student’s t-test. Results: No difference was found in overall volume of penetration between early and late cement application (P = .16). Beneath the baseplate, the layered technique had significantly less penetration and averaged less than 3 mm with early and late cement. The gun technique had the greatest depth of penetration with early cement and averaged greater than 3 mm in all zones regardless of cement working time. The osteotome technique achieved significantly greater depth of penetration around the keel with early and late cement, P < .01. Conclusions: Using a cement gun ensures adequate penetration beneath the baseplate regardless of cement working time while the osteotome technique is effective to increase penetration around the implant keel. According to our study, applying cement early in its working time may not increase volume of penetration. This study raises concern regarding adequate cement penetration using the layered technique for cementing the tibial component in total knee arthroplasty, and future research is warranted.

1 A More recent follow-up brain MRI (2019) revealed medulloblastoma treatment-related effects. Her past medical history was notable for thrombophilia due to factor V Leiden (heterozygosis) and cerebellar medulloblastoma (MB) diagnosed at the age of 7, treated with surgical resection followed by radio- and chemo-therapy. Keywords: MOG; Meningitis; Aseptic; MOGAD; Autoimmune EN MOG Meningitis Aseptic MOGAD Autoimmune 1131 1134 4 02/15/23 20230301 NES 230301 Giorgia Andrini and Gian Maria Asioli contributed equally to this work. [Extracted from the article]

Revision of both femoral and tibial components of a total knee arthroplasty (TKA) for aseptic loosening has favorable outcomes. Revision of only one loose component with retention of others has shorter operative time and lower cost; however, implant survivorship and clinical outcomes of these different operations are unclear. Between January 2009 and December 2019, a consecutive cohort of revision TKA was reviewed. Univariate and multivariable analyses were used to study correlations among factors and surgical related complications, time to prosthesis failure, and functional outcomes (University of California Los Angeles, Knee Society functional, knee osteoarthritis and outcome score for joint replacement, Veterans RAND 12 (VR-12) physical, and VR-12 mental). A total of 238 patients underwent revision TKA for aseptic loosening. The mean follow-up time was 61 months (range 25 to 152). Ten of the 105 patients (9.5%) who underwent full revision (both femoral and tibial components) and 18 of the 133 (13.5%) who underwent isolated revision had subsequent prosthesis failure [Hazard ratio (HR) 0.67, P =.343]. The factor analysis of type of revision (full or isolated revision) did not demonstrate a significant difference between groups in terms of complications, implant failures, and times to failure. Metallosis was related to early time to failure [Hazard ratio 10.11, P <.001] and iliotibial band release was associated with more complications (Odds ratio 9.87, P =.027). Preoperative symptoms of instability were associated with the worst improvement in University of California Los Angeles score. Higher American Society of Anesthesiologists status and higher Charlson Comorbidity Index were related with worse VR-12 physical (−30.5, P =.008) and knee osteoarthritis and outcome score for joint replacement (−4.2, P =.050) scores, respectively. Isolated and full component revision TKA for aseptic loosening does not differ with respect to prosthesis failures, complications, and clinical results at 5 years. Poor American Society of Anesthesiologists status, increased comorbidities, instability, and a severe bone defect are related to worse functional improvement. III, cohort with control. [ABSTRACT FROM AUTHOR]

Introduction: While the demand for aesthetic procedures is rising, complications are rising alongside. Infection is a frequent complication, there is therefore an increased need for strict aseptic technique, particularly in procedures breaching the skin. The level of training of practitioners carrying out these procedures varies and there are no comprehensive guidelines on aseptic aesthetic practice in the Benelux region. Objective: Developing a step‐by‐step procedure for achieving and maintaining a high standard of aseptic conditions in a standard aesthetic practice in the Benelux region. Methods: A consensus group of 10 aesthetic medical practitioners (dermatologists, plastic surgeons, and cosmetic physicians) representing the Benelux region convened to discuss best practice for aseptic techniques in medical aesthetics. Step‐by‐step procedures were recommended to achieve optimal aseptic practice in private facilities and define important considerations for reducing infection risk. Recommendations were based on current evidence and extensive clinical experience. Results: Recommendations were made to achieve and maintain a high standard of asepsis and infection control. Guidance included maintaining high standard aseptic conditions of the injecting room, the injecting area on the patient, the injection procedure, the materials, and procedures commonly used to achieve aseptic conditions. Conclusions: This expert consensus summary publication recommends aseptic procedures, setting a standard with the goal of minimizing rates of complications in aesthetic clinical practice in the Benelux region. [ABSTRACT FROM AUTHOR]

Nonunion is defined as the failure of a fracture to heal in twice the usual period of time (at least 9 months after trauma); the fracture gap is bridged by fibrous tissue or fibrocartilage instead of bone tissue. The main clinical signs are abnormal mobility with or without local tenderness. Radiographic signs include persistence of fracture line, sclerosis of bone ends, hypertrophic callus formation or atrophic bone resorption, and possibly, radiolucency around osteosynthetic devices. Decision-making is important in treating any type of nonunion. The first and most important step is to rule out infection and decide whether septic or aseptic nonunion and atrophic or hypertrophic variety. Next step is to differentiate whether it is stiff or mobile nonunion by clinically. Associated problems are to be identified, including adjacent joint involvement, presence of bone gap, stability at the fracture or fixation site, and presence of limb-length discrepancy. Hence, the treatment needs to be individualized. Several options are available, including plates, nails, and external fixators. Ring fixator is more versatile in managing these conditions as they allow early weight-bearing and allow simultaneous correction of limb-length discrepancy and deformity. [ABSTRACT FROM AUTHOR]

Laboratories have made considerable use of laminar airflow cabinets to create a microorganism-free environment with excellent and consistent results. Providing a laminar airflow cabinet at a high price is one of the factors involved. Consequently, a similar-functioning alternative to the standard laminar airflow tool is required. The objective of this research was to create a miniature laminar airflow cabinet. Interview and observational data were collected via questionnaires for the experiments. Examination of the data utilized by the Likert scale mini laminar airflow (MLAF) was able to create a sterile workplace with the high efficacy of laminar airflow, HEPA filtration, and a high air-change rate, as demonstrated by the results. 82.50% of respondents indicated that the effectiveness of MLAF supported any laboratory work requiring a sterile environment, as indicated by the mean questionnaire answer. [ABSTRACT FROM AUTHOR]

Background: During aseptic revision total joint arthroplasty (TJA), one or more cultures may occasionally isolate an organism. The hypothesis of this study was that in a portion of patients undergoing revision arthroplasty for aseptic failure, culture may isolate an organism(s) that can be left untreated.Methods: All patients undergoing revision TJA from 2000 to 2017 at two institutions were retrospectively reviewed. Patients were categorized as aseptic if they were appropriately investigated preoperatively and did not meet the 2018 International Consensus Meeting criteria. In the aseptic revision cohort, patients with a single positive culture or multiple cultures positive for different organisms ("organism-positive") and patients who had negative intraoperative cultures ("organism-negative") were compared based on demographics, comorbidities, operative details, subsequent reoperations, and periprosthetic joint infection (PJI).Results: In total, 3,234 International Consensus Meeting-negative aseptic revision TJAs were included, of which 215 patients (6.6%) were organism-positive, 196 (91.2%) had a single positive culture, and 19 (8.8%) were positive for 2 or more distinct organisms (ie, polymicrobial). The most prevalent organisms were coagulase-negative Staphylococci (37.5%), Staphylococcus epidermidis (9.6%), and Cutibacterium acnes (8.0%). Demographics and operative details were comparable between the groups. Using multiple regressions there was no association between culture positivity and the rate of reoperation or PJI.Conclusion: Isolation of organisms by culture in patients undergoing revision for aseptic failure was not uncommon. As long as these patients were appropriately investigated preoperatively and PJI was excluded, these findings suggest that culture results may be ignored without subjecting patients to additional antimicrobial treatment. [ABSTRACT FROM AUTHOR]

Background: Despite contributing to significant morbidity in working-age adults, there is no consensus on the optimal treatment for prepatellar bursitis. Much of the existing literature combines prepatellar and olecranon bursitis. This systematic review aims to determine the optimal management of prepatellar bursitis. Study design and methods: A primary search of electronic published and unpublished literature databases from inception to November 2019 was completed. Articles over 25 years old, case reports with less than four patients, paediatric studies, and non-English language papers were excluded. Our primary outcome was recurrence after 1 year. Comparisons included endoscopic vs open bursectomy, duration of antibiotics. Methodological quality was assessed using the Institute of Health Economics and Revised Cochrane Risk of Bias scoring systems. Meta-analyses were conducted where appropriate. Results: In total 10 studies were included (N = 702). Endoscopic and open bursectomy showed no difference in recurrence after 1 year (OR 0.41, 95% CI 0.05–3.53, p = 0.67), and surgical complications (OR 1.44, 95% CI 0.34–6.08, p = 0.44). 80% endoscopically-treated patients were pain free after 1 year. Patients treated with antibiotics for less than 8 days were not significantly more prone to recurrence (2/17 vs 10/114, OR 0.66, 95% CI 0.13–3.29, p = 0.64) compared to 8 days plus at minimum 1 year post injury. Conclusions: Our study represents the largest cohort of patients evaluating management strategies for prepatellar bursitis, and includes data not previously published. Endoscopic bursectomy is non-inferior to open bursectomy, enabling a shorter hospital stay. It also offers a relatively low risk of post-operative pain. Endoscopic bursectomy is a viable option to treat both septic and aseptic prepatellar bursitis. Our small cohort suggests recurrence and hospital stay are not improved with antibiotic treatment exceeding 7 days for septic prepatellar bursitis. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to compare the functional outcomes, activity levels, mortalities, implant survival rates, and complications in revision total knee arthroplasty (TKA) of patients with septic loosening with those in patients with aseptic loosening over a minimum 10-year follow-up period. Methods A cohort of 78 patients (36 septic loosening and 42 aseptic loosening) was selected between January 2008 and December 2009. The functional outcomes, activity levels, mortalities, implant survival rates, and complications of revision TKA in patients with septic and aseptic loosening were compared. Results The mean Knee Society knee scores in the septic and aseptic groups improved from 36.7 and 37.4 preoperatively to 65.3 and 76.8 points at the final follow-up, respectively (p

The purpose of this study was to share the clinical, functional and radiological results of patients who underwent revision total knee arthroplasty (RTKA) for septic or aseptic loosening after total knee arthroplasty. 34 patients who were diagnosed with septic (n=19) or aseptic (n = 15) loosening after total knee arthroplasty and underwent single stage (aseptic group) or two-stage (septic group) RTKA surgery between May 2015 and June 2020 were analyzed retrospectively. Patients with septic loosening were checked again with clinical and laboratory evaluations for the second stage of revision surgery at the postoperative 3rd and 6th weeks. The changes in the joint line before and after the surgery were measured radiographically. The classification of the defects was performed by using the Anderson Orthopedic Research Institute criteria. Preoperative and postoperative Knee Society Score (KSS) was completed by all patients. KSS scores were a statistically significant increase observed in the postoperative values compared to the preoperative ones in both groups (p = 0.001). Moreover, there was a statistically higher increase observed among the aseptic loosening patients compared to the septic patients and the preoperative period in the KSS scores (p = 0.001). In terms of the preoperative distance between the fibular styloid and distal part of the femoral component used in the evaluation of the joint line, it was observed that postoperatively, there was a higher increase in among the patients with septic loosening TKA compared to the aseptic loosening TKA (p = 0.002). As a result, restoration of the joint line is a very important parameter in RTKA, and the increase in joint distance negatively affects the results clinically and functionally. Two-stage surgical treatment in septic loosening TKA is an effective and successful surgical method for the prevention reinfection. [Med-Science 2021; 10(3.000): 706-13]

Radiographic osteolysis after total shoulder arthroplasty (TSA) remains a challenging clinical entity, as it may not initially manifest clinically apparent symptoms but can lead to clinically important complications, such as aseptic loosening. A thorough consideration of medical history and physical examination is essential to rule out other causes of symptomatic TSA--namely, periprosthetic joint infection--as symptoms often progress to vague pain or discomfort due to subtle component loosening. Once confirmed, nonoperative treatment of osteolysis should first be pursued given the potential to avoid surgery-associated risks. If needed, the current surgical options include glenoid polyethylene revision and conversion to reverse shoulder arthroplasty. The current article provides a comprehensive review of the evaluation and management of osteolysis after TSA through an evidence-based discussion of current concepts. [ABSTRACT FROM AUTHOR]

Background: Although tourniquet use in primary total knee arthroplasty (TKA) has been widely studied, the outcomes associated with tourniquet use in revision TKA (rTKA) remains relatively unexplored. This study investigates surgical outcomes and patient satisfaction in association with tourniquet use during aseptic rTKA.Methods: We retrospectively reviewed all patients who underwent rTKA for aseptic causes at our institution from 2011 to 2020. Patients were separated into 2 cohorts based on tourniquet inflation during the procedure. Outcomes of interest included estimated blood loss, change in hemoglobin, surgical time, length of stay, reoperation rate, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) scores.Results: Of the 1212 patients included, 1007 (83%) underwent aseptic rTKA with the use of a tourniquet and 205 (17%) without the use of a tourniquet. The mean tourniquet inflation time was 93.0 minutes (standard deviation 33.3 minutes). Blood loss was significantly less for patients in the tourniquet cohort as measured through estimated blood loss (224.1 vs 325.1 mL, P < .001) and change in preoperative to postoperative hemoglobin (1.75 vs 2.04 g/dL, P < .001). There were no statistical differences in surgical time (P = .267) and length of stay (P = .206) between the 2 groups. The reoperation rate was significantly greater for patients who did not have a tourniquet utilized (20.5% vs 15.0%, P = .038). Delta improvement in KOOS, JR scores from baseline to 3 months postoperatively did not statistically differ between the 2 cohorts (P = .560).Conclusion: Although delta improvements in KOOS, JR scores were similar for both cohorts, patients who did not have a tourniquet inflated during aseptic rTKA had increased blood loss and were more likely to undergo subsequent reoperation compared to patients who did.Level Iii Evidence: Retrospective Cohort Study. [ABSTRACT FROM AUTHOR]

BACKGROUND: The application of 3D bioprinting is becoming more and more extensive, and the related bio-ink sterilization is very important. However, the sterilization problem of bio-ink used for clinical purposes has not been resolved. OBJECTIVE: To summarize the current research progress of bio-ink sterilization technology for 3D bioprinting. METHODS: Retrieve relevant documents were retrieved on CNKI, Wanfang Data Platform, PubMed, and Web of Science databases, with the search terms of “3D bioprinting, tissue engineering, additive manufacturing, bio-ink, biomaterials, sterilization, disinfect, aseptic”. Finally, 77 relevant articles were included for review. RESULTS AND CONCLUSION: Different sterilization methods have bad effects on bio-ink for 3D bioprinting while sterilizing bio-ink. (1) Some sterilization methods can damage the microstructure in the biological ink. For example, radiation sterilization and ultraviolet light produced free radicals can affect biological fluid mechanics and plasticity of ink. Acetic acid peroxide dissolved biological ink ingredients due to its strong oxidizing. The mechanical performance requirements of high material should reduce to use this kind of sterilization method. (2) Some sterilization methods can damage the activity of the biological ink containing biological macromolecules, such as autoclaving of high-energy water vapor, radiation sterilization, and ultraviolet light produced free radicals can lead to loss of biological macromolecules such as protein and enzyme activity. Therefore, biological ink that requires biological macromolecules to be active should reduce to use this kind of sterilization method. (3) Some sterilization methods will remain some toxic substances: for example, ethylene oxide sterilization residues have carcinogenicity and affect the survival of seed cells, so the biological ink that needs to be loaded with seeds should reduce the use of this sterilization method. (4) Some sterilization methods for ink cannot complete a thorough sterilization. For example, ethanol and antibiotic during sterilization limited by its own nature cannot always be completed on biological sterilization of ink, so it often needs to be combined with other methods, such as the combination of different kinds of antimicrobial and the combination of peracetic acid with ethanol, which can not only realize the complementary advantages bus also avoid additional adverse effects. (5) Therefore, the material characteristics, the purpose of material application and the principle of sterilization should be considered when selecting the optimal bio-ink sterilization method for 3D bioprinting. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to report midterm outcomes and survivorship of a bicruciate retaining knee arthroplasty compared with a bicruciate sacrificing anterior stabilized knee arthroplasty.Methods: A retrospective comparative cohort analysis was performed of all patients who underwent primary total knee arthroplasty with the bicruciate retaining (XP) knee arthroplasty compared with an anterior stabilized (AS) cruciate sacrificing bearing. The XP system was used in 195 knees and was compared with 1471 knees in which the AS bearing was used. Patients were included in analysis if they had minimum 2-year follow-up or had a revision at any point. Preoperative and postoperative range of motion, Knee Society Scores, complications, and reoperations were evaluated. Unpaired t-test and chi-square analysis were performed. Kaplan-Meier survival analysis was performed for all-cause and aseptic survival.Results: At an average of 5.2-year follow-up, 22 (11.3%) XP knees had been revised, compared with 23 (1.6%) AS knees (P < .001). Nineteen (9.7%) XP knees were revised for aseptic tibial loosening; one (0.1%) of the AS knees was revised for the same (P < .001). Nineteen of the XR revision surgeries (86.4%) were for aseptic tibial loosening. Compared with AS knees, the XP knees had significantly lower improvement in range of motion (3.2 deg vs 2.2 deg, P < .001), Knee Society (KS) pain scores (39 vs 35.7, P = .014), KS clinical scores (52.4 vs 46, P < .001), and KS functional scores (20.9 vs 15.5, P = .01).Conclusion: The bicruciate retaining Vanguard XP Total Knee System demonstrated an unacceptably high rate of aseptic tibial loosening without conferring the benefit of improved postoperative function relative to other available bearings. [ABSTRACT FROM AUTHOR]

Cancer is on the rise both globally and in South Africa, with an estimated 70% increase in incidence in Sub-Saharan Africa by 2030. While oncology pharmacy is a highly specialized field of practice, there is currently no formal certification for oncology pharmacists in South Africa. To standardise the way in which oncology pharmacy is practiced within the country, the first-ever simulation-based oncology admixing training for pharmacy students in South Africa was developed at the University of the Witwatersrand. Following the simulation, a survey was conducted to determine the participants' perceptions of the simulation. Current and past pharmacy students were invited to complete a questionnaire. Data were collected through a self-administered cross-sectional REDCap (Research Electronic Data Capture) questionnaire using a Likert-like scale to determine the agreed with statements related to the simulation. A total of 81 participants completed the questionnaire. Participants provided favorable feedback related to the simulation's benefit, quality, and learning experience. Based on the perceptions of the participants, the purpose of the simulation exercise was achieved. [ABSTRACT FROM AUTHOR]

In the fruit processing sector, one possible way to eliminate differences due to seasonality and location is aseptic preservation. This eliminates the need to use natural, added material to increase the shelf life of aseptic fruit puree semi-finished products without significant deterioration. In the production technology of aseptic marrow semi-finished products, in addition to color fixation, in addition to the addition of ascorbic acid, the production is also included. The latest customer demands, but the omission of ascorbic acid is certainly being asked with this additive-free product. The aim of this work was to study effect of the storage time and to examine how the biologically valuable component content changes in aseptic filled "Idared" apple juice. Acerola juice (1430 mL x kg-1) or ascorbic acid (200 g x kg-1) was added to the apple juice to enrich the amount of valuable component and the changes of measured parameters were monitored during the 12 months storage. The antioxidant capacity [1], total polyphenol content [2], and color coordinate values (Konica Minolta-CR-400) of aseptically filled apple juice were determined and compared with the control sample. No significant difference in color coordinates was observed between ascorbic acid-, acerola-enriched and control samples. After four month storage, the polyphenol contents of the samples shown remarkable decrease except the control ones. By the end of the storage period, the samples enriched with acerola had the highest total polyphenol content. The antioxidant capacities of apple juices also increase during storage by sixth month. Then the antioxidant capacity values reduced in the control sample and ascorbic acid enriched juice, opposite its amount in the acerola-enriched version increased slightly and then stagnated until the end of the storage time. The most prominent results were obtained for acerola treated samples in both case of the fruits. There is a significant difference against the ascorbic acid treated samples and the acerola treated samples in the color parameters. It is a very important aspect in terms of industrial processing because much less quantity is enough to add the juice from ascorbic acid than acerola what makes the whole process cheaper. After six month there is a definite decline of all of amount of the bioactive substance. [ABSTRACT FROM AUTHOR]

Introduction: Humeral loosening (HL) is an uncommon indication for revision shoulder arthroplasty. This systematic review describes patient characteristics (prosthetic type removed, reimplanted, and septic vs. aseptic loosening status), re-revision rate, and outcomes following revision surgery for a loose humeral stem., Materials and Methods: An electronic database search of PubMed, Scopus, Embase, and Cochrane was conducted accordant to the Preferred Reporting Items for Systematic Reviews and Meta-analyses method. Studies that reported information on patients who had revision arthroplasty due to HL and reported their postrevision outcomes were included in this review., Results: Our review included 13 studies, from which 119 revision cases due to HL were extracted. The prostheses subtypes revised for HL were 48.7% (58/119) anatomic total shoulder arthroplasties (TSAs), 46.2% (55/119) reverse shoulder arthroplasties (RSAs), and 5.0% (6/119) hemiarthroplasties (HAs). The implants used to revise patients with HL were 52.2% (59/113) RSAs, 35.4% (40/113) HAs, and 12.4% (14/113) TSAs. Septic loosening occurred in 11.7% (14/119) of the cases. Ninety-seven cases provided details regarding subsequent revisions, of which 28.9% (28/97) were re-revised. The following outcome scores were available: mean satisfaction rate was 71.4% (n = 49), the mean total American Shoulder and Elbow Surgeons score was 52.5 (range 30-66) (n = 28), and the mean Constant score was 40.3 (range 34-41.3) (n = 14)., Conclusion: The most revised implants for HL were TSAs and RSAs. Reverse shoulder arthroplasties were the most common implants used for revision, followed by HAs. Aseptic loosening accounted for most cases, suggesting that infection is rarely the primary cause of HL. There is a pronounced risk of re-revision for recurrent HL. The irregular reporting of validated outcome scores makes it difficult to draw definitive conclusions regarding the treatments of these patients., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purposes: This study aimed to evaluate the sensitivity and specificity of the sonication cultures according to the International Consensus Meeting 2018 criteria and to evaluate the effect of sonication on the antibiotic treatment of patients.Methods: Sixty-four patients who were scheduled for revision hip or knee arthroplasties were included in the study. Aspiration fluid, tissue, and sonication cultures were performed from all patients and compared in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Other targets of the study were to investigate the rate of change in the antibiotic treatment.Results: The sensitivity, specificity, PPV, NPV, and overall accuracy of the fluid culture obtained by the sonication method were 71.4%, 96.6%, 96.2%, 73.7%, and 82.8%, respectively. The sensitivity, specificity, PPV, NPV, and overall accuracy of the fluid culture obtained after tissue sampling were 68.6%, 100%, 100.0%, 72.5%, and 82.8%, respectively. There was no statistically significant difference between the sonication method and tissue culture in terms of sensitivity and specificity (p = 1.0). The sensitivity, specificity, PPV, NPV, and overall accuracy of the fluid culture obtained by the aspiration method were 28.6%, 93.1%, 83.3%, 51.9%, and 57.8%, respectively. Treatment change was applied in 10 (15.6%) patients.Conclusion: Our prospectively collected data revealed that sonication of the explants alone did not increase the sensitivity, and we found that sonicate culture sometimes changed the antibiotic therapy strategy in patients with periprosthetic joint infection because different microorganisms were detected.Trial Registration: This study was prospectively registered in a public trials registry ( https://clinicaltrials.gov/ , NCT04304885). [ABSTRACT FROM AUTHOR]

Purpose: Despite good clinical outcomes and a high success rate, there is a comparatively high mortality after one stage septic exchange of total hip arthroplasty. The aim of this study was to identify risk factors for mortality in the hospitalization period after one-stage septic exchange of THA. Methods: We retrospectively analyzed in our database all patients who had a one-stage septic exchange for periprosthetic infection of THA and died during hospitalization (n = 33). The control group was matched semi-randomly by surgical procedure (n = 121) who did not die during hospitalization. The two groups were analyzed for risk factors such as age, Charlson Comorbidity Index (CCI), and high-/low-virulence bacteria. Results: In the deceased group, 16 patients were female and 17 were male with a mean age at surgery of 73.2 years. In the control group, there were 55 females and 66 males with an average age at surgery of 68.2 years. Comparing the two groups, the deceased group had a significantly higher proportion of liver disease as well as higher rate of pulmonary embolism, apoplexy, and/or myocardial infarction, an increased CCI with an average of 6.5 and advanced age. Further demographic and surgery-related parameters especially high- or low-virulent germs were not identified as risk factors for mortality during the hospitalization period. The binominal logistic regression analysis showed that the probability of an inpatient death following one-stage septic exchange of THA increases by a factor of 3.079, with each additional point of the CCI. Conclusion: In conclusion, advanced age and high CCI are the main risk factors for mortality after single-stage septic change of THA. However, high-virulence bacteria have no influence on the mortality during the hospitalization period after one-stage septic exchange of THA. [ABSTRACT FROM AUTHOR]

Purpose: Aim of this study was to determine the rate of low-grade infection in patients with primarily as aseptic categorized tibial shaft nonunion and lack of clinical signs of infection.Methods: In a retrospective study between 2006 and 2013, all patients who underwent revision surgery for treatment of tibial shaft nonunion without clinical evidence of infection were assessed. Bacterial cultures harvested during nonunion revision, C-reactive protein (CRP) and/or white blood cell (WBC) values at hospital admission, outcome, and epidemiological data were analyzed.Results: In 88 patients with tibial shaft nonunion without any clinical signs of infection, bacterial samples remained negative in 51 patients. In 37 patients, microbiological diagnostic studies after long-term culturing demonstrated positive bacterial cultures whereas after short-term culturing for 2 days only 17 positive cultures were observed. In 12 cases a mixed culture with 2.3 different bacteria on average was detected. Among patients with negative bacterial cultures bone healing was achieved after 13.2 months. Nonunion with positive bacterial cultures required 19 (range 2-42) months until osseous healing (p = 0.009). Furthermore, nonunion with positive bacterial cultures require statistically more surgical revisions to achieve healing (2.9 ± 0.5 vs. 1.3 ± 0.1 additional procedure; (p = 0.003). Hematological studies carried out before surgical intervention did not demonstrate significant differences in CRP values (negative vs. positive cultures: 0.3 (range 0.3-2.8) mg/dl vs. 0.5 (range 0.3-5.7) mg/dl (p = 0.181) and in WBC values (negative vs. positive cultures: 7.4 (range 3.5-11.9) /nl vs. 7.3 (range 3.7-11.1) /nl (p = 0.723). Limitations of this study may include the varying amount of the at least four samples for microbiological diagnostics as well as the circumstance that for diagnosing low-grade infection swabs and tissue samples were included in this evaluation as being equivalent.Conclusion: The pathogenesis of nonunion may originate from low-grade infection even in patients without clinical signs of infection. In addition, nonunion with positive bacterial cultures require statistically more surgical revisions to achieve healing. Therefore, during any revision surgery, multiple bacterial samples are intended to be harvested for long-term culturing. Particularly, in tibial shaft nonunion following Gustilo-Anderson type III open fractures, low-grade infection should be suspected.Trial Registration Number: DRKS00014657.Date Of Registration: 04/26/2018 retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the functional outcomes, activity levels, mortalities, implant survival rates, and complications in revision total knee arthroplasty (TKA) of patients with septic loosening with those in patients with aseptic loosening over a minimum 10-year follow-up period. Methods: A cohort of 78 patients (36 septic loosening and 42 aseptic loosening) was selected between January 2008 and December 2009. The functional outcomes, activity levels, mortalities, implant survival rates, and complications of revision TKA in patients with septic and aseptic loosening were compared. Results: The mean Knee Society knee scores in the septic and aseptic groups improved from 36.7 and 37.4 preoperatively to 65.3 and 76.8 points at the final follow-up, respectively (p < 0.05). Outdoor ambulatory patients at the final follow-up included 20 of 29 (69.0%) patients in the septic group and 35 of 39 (89.7%) patients in the aseptic group (p < 0.05). The cumulative mortality rates in the septic and aseptic groups were 19.4% (7/36) and 7.1% (3/42) (p = 0.102) at final follow-up, respectively. Kaplan–Meier survivorship analysis with re-revision of either component as an endpoint in the septic and aseptic groups estimated 86.5% and 95.5% chance of survival for 10 years, respectively. Conclusions: Revision TKA in patients with septic loosening had worse functional outcomes and higher mortality over a minimum 10-year follow-up period compared with that in patients with aseptic loosening. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Stethoscope hygiene is rarely performed despite evidence that they are a potential source of nosocomial infections. Aseptic touch-free disposable stethoscope diaphragm barriers (touch-free barriers) provide a bacteriologically impervious surface; however, little is known about perceptions of touch-free barriers. The purpose of this study was to determine patients' and healthcare professionals' perceptions of stethoscope hygiene habits, cleanliness, and patient safety, after respondents viewed videos of stethoscope hygiene with alcohol versus a touch-free barrier, or no hygiene/no barrier. We conducted a cross-sectional study using survey methodology and convenience sampling. Participants viewed three short videos that showed a provider using each of three stethoscope hygiene techniques (barrier, alcohol, or none), followed by completion of a brief survey. Pearson's chi-square, Fisher's exact, Wilcoxon rank sum or Kruskal-Wallis tests were used as appropriate. Bonferroni correction was used to control error rate at 0.05 for each question. The sample size of 240 participants included 119 patients and 121 healthcare professionals. Patients rarely witnessed healthcare professionals cleaning stethoscopes, rated clean stethoscopes as important, and were more likely to choose touch-free barrier as easiest for providers. Healthcare professionals rated stethoscope hygiene as important, reported frequent stethoscope hygiene, and felt that touch-free barrier would improve workflow. Touch-free barriers were viewed positively by respondents. Hospitals should consider touch-free barriers as an important strategy to reduce nosocomial infections. [ABSTRACT FROM AUTHOR]

Abstract Background Intravenous catheter (IVC) use in hospitalized ruminants is a common procedure. Limited information is available describing complications associated with IVCs. Hypotheses Prevalence of IVC infections in hospitalized ruminants is >50%. Intravenous catheters maintained for >5 days are more likely to be infected than those maintained for 4 days had a higher likelihood of being infected than those maintained for 4 days to reduce IVC infection.

The purpose of this study was to share the clinical, functional and radiological results of patients who underwent revision total knee arthroplasty (RTKA) for septic or aseptic loosening after total knee arthroplasty. 34 patients who were diagnosed with septic (n=19) or aseptic (n = 15) loosening after total knee arthroplasty and underwent single stage (aseptic group) or two-stage (septic group) RTKA surgery between May 2015 and June 2020 were analyzed retrospectively. Patients with septic loosening were checked again with clinical and laboratory evaluations for the second stage of revision surgery at the postoperative 3rd and 6th weeks. The changes in the joint line before and after the surgery were measured radiographically. The classification of the defects was performed by using the Anderson Orthopedic Research Institute criteria. Preoperative and postoperative Knee Society Score (KSS) was completed by all patients. KSS scores were a statistically significant increase observed in the postoperative values compared to the preoperative ones in both groups (p = 0.001). Moreover, there was a statistically higher increase observed among the aseptic loosening patients compared to the septic patients and the preoperative period in the KSS scores (p = 0.001). In terms of the preoperative distance between the fibular styloid and distal part of the femoral component used in the evaluation of the joint line, it was observed that postoperatively, there was a higher increase in among the patients with septic loosening TKA compared to the aseptic loosening TKA (p = 0.002). As a result, restoration of the joint line is a very important parameter in RTKA, and the increase in joint distance negatively affects the results clinically and functionally. Two-stage surgical treatment in septic loosening TKA is an effective and successful surgical method for the prevention reinfection. [ABSTRACT FROM AUTHOR]

Background: Revision total knee arthroplasty (TKA) involves varying levels of case complexity and costs depending on the following: (1) number of components revised, (2) duration of operating room time, and (3) length of hospital stay. However, the cost associated with different types of aseptic TKA revisions, based on number and type of components revised, is not well described. We sought to determine differences in cost associated with different revision types, and to correlate this with average national hospital and surgeon reimbursement based on current Centers for Medicare and Medicaid Services data.Methods: This is a retrospective review of aseptic revision TKAs performed at a single tertiary referral center from 2015 to 2018. Patient demographic data, operating room time, and direct surgery and total hospital costs obtained from an internal accounting database (Enterprise Performance Systems, Inc) were collected. Patients were stratified by the components revised (polyethylene liner only, tibia only, femur only, or both femur and tibia). We hypothesized that direct surgery and total hospital costs would increase as case complexity increased from poly exchange to single-component revisions and both-component revisions.Results: In total, 106 patients were included (19 poly exchanges, 10 tibia-only revisions, 13 femur-only revisions, and 64 both-component revisions). Operating room time was significantly lower for poly exchange than all other groups (P < .001). Direct surgery and total hospital costs were significantly lower for poly exchange than all other groups (P < .001), and were significantly lower for tibia-only and femur-only revisions compared to both-component revisions (P < .001). Average national surgeon reimbursement by Medicare decreased as a percentage of direct surgery cost as case complexity increased from poly exchange to tibia-only, femur-only, and both-component revisions. Total hospital cost per average Diagnosis Related Group weight was lowest for single-component revisions and highest for both-component revision.Conclusion: There are significant differences in cost associated with aseptic TKA revisions based on number and type of components revised. These differences may not be accurately reflected in reimbursement, and often represent a burden to those who treat complex revisions. [ABSTRACT FROM AUTHOR]

Periprosthetic infection (PJI) remains a challenging complication in total shoulder arthroplasty. Surgical treatment options can include 1 or 2-stage revision procedures, temporizing articulating spacers, and resection arthroplasty, with many cases resulting in transfer of patient care to a tertiary care center. While these cases can impose significant cost and clinical burden for both surgeons and hospital systems, there is limited data about the operative time investment and reimbursement compared to aseptic revision cases. The purpose of the current study was to compare work relative value units and operative times for aseptic and septic shoulder arthroplasty revision procedures. We hypothesize that staged, PJI-related revision shoulder arthroplasty is associated with significant differences in operative time and work relative value units assigned as compared to aseptic revisions. This study utilized data obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Inclusion criteria included all patients that underwent a revision total shoulder arthroplasty between January 1, 2010 and December 31, 2018. Procedures were grouped as either aseptic or septic revisions and further stratified into 1 stage and each stage of a 2-stage revision for septic cases. The RVU-to-dollar conversion factor was provided by the United States Centers for Medicare and Medicaid Services (CMS). This was used to obtain total reimbursement and reimbursement per minute estimates. When assessing the ratio of RVUs per minute of operative time across the groups, we found that the second stage of a 2-stage septic revision had a significantly lower RVU per minute operative time ratio (0.25) when compared to both the aseptic 2-component revision (0.34) and the first stage of a 2-stage septic revision (0.29). This translated to a significantly lower dollar per minute operative time value. The current study found that the second stage of a 2-stage septic revision was undervalued in the number of RVUs per minute of operative time when compared to an aseptic revision or even its first stage counterpart. An adjustment or redistribution of relative value units for these procedures may offset the disproportionate clinical burdens encountered with definitive treatment of these complications. Level III. [ABSTRACT FROM AUTHOR]

The protocol of aseptic cryoprotectant-free vitrification on human spermatozoa is well documented. However, data about the effect of permeable cryoprotectants at this procedure is limited. Presented study aimed to test the aseptic capillary vitrification technologies using permeable cryoprotectant-included or cryoprotectant-free media. Thirty-two normal samples were included and analyzed after vitrification in three different media and thawing. Three treatment groups were formed: Group 1, basic medium; Group 2, basic medium with 0.25 M sucrose; Group 3, basic medium with glycerol. Before plunging into liquid nitrogen, capillaries were filled by 10 μl of spermatozoa suspension and isolated from liquid nitrogen by location in hermetically closed 0.25 ml straws. Progressive motility, plasma membrane integrity, total motility/viability after 24, 48 and 72 h in vitro culture, apoptosis and mitochondrial membrane potential (ΔΨm) were determined after thawing at 42 °C. Progressive motility of spermatozoa in groups 1, 2, 3 was 24.9 ± 1.7%, 34.5 ± 2.8% and 34.0 ± 1.4%, respectively (P 1-2,3 <0.05). The plasma membrane integrity of spermatozoa in groups 2 and 3 (48.4 ± 2.9% and 45.5 ± 3.9%, respectively) was higher than in Group 1 (33.3 ± 2.1%, P < 0.05). After 24 h, 48 h and 72 h in vitro culture, the total motility and viability of spermatozoa in Group 1 was significantly lower than Group 2 and Group 3. The apoptosis rate in Group 3 (44.5 ± 3.0%) and Group 2 (47.7 ± 4.1%) were lower than in Group 1 (52.5 ± 4.4%; P < 0.05). ΔΨm rates in Group 3 and Group 2 were higher than in Group 1 (P < 0.05) with no statistical differences between this parameter in Group 2 and Group 3 (P > 0.1). In conclusion, supplementation of medium for aseptic capillary technology for cryoprotectant-free vitrification of human spermatozoa by permeable cryoprotectant does not improve the quality of spermatozoa after warming. [ABSTRACT FROM AUTHOR]