Component Rotation in Well-Functioning, Gap Balanced Total Knee Arthroplasty Without Navigation.

BACKGROUND: Malalignment of total knee arthroplasty (TKA) components is a potential cause of clinical failure following TKA. Since the goal of a gap balancing (GB) technique is equal flexion and extension gaps secondary to soft-tissue balancing, and not necessarily component alignment, variation in component placement may exist. Our purpose was (1) to evaluate precision of component alignment in well-functioning GB TKAs performed without the aid of navigation using computed tomographic evaluation and (2) to determine any relationship between femoral version and/or tibial torsion and TKA component positioning. METHODS: There were 93 well-functioning TKAs performed with an extension gap first GB technique with a minimum 2-year follow-up evaluated using computed tomography to assess component rotational alignment, as well as osseous femoral version and tibial torsion. Femoral and tibial rotational alignment was assessed by previously described methods. RESULTS: The mean Knee Society Score was 185.7 ± 21.7. The mean range of motion was 128.5 ± 7.8°. Femoral posterocondylar axis (relative to the transepicondylar axis) values ranged from -8.3 to 4.1° with a mean of -0.78 ± 2.7° (internal rotation). Mean tibial rotation was 17.2 ± 7.9° internal rotation relative to the tibial tubercle. No correlation was found between native femoral version and femoral component rotational alignment (Pearson's correlation coefficient, r, 0.007). Weak correlation was found between native tibial torsion and tibial component alignment (r = 0.24). CONCLUSION: Despite being only a secondary objective with the GB technique, most components evaluated were within the desired range of rotation. Alignment was not influenced by native osseous rotational geometry. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study.

Self-regulation of time: The importance of time estimation accuracy.

Time management is one central aspect of students' self-regulated learning. In addition, biased time estimation seems to be central to students' self-regulation of their time. In this study, we explored college students' time estimation bias. In addition, we were interested in whether the activation of task beliefs influenced students' time estimation bias and how specific beliefs about task difficulty influence time estimation bias. Findings suggested that students tended to demonstrate bias in their estimations of the time their academic tasks would take. Additionally, the activation of task beliefs did not influence students' time estimation accuracy. Finally, both prior task difficulty and anticipated difficulty influenced students' time estimation bias. These findings highlight the complexity of students' time estimation bias and point to the opportunities for future directions.

Effectiveness of Manual Terminal Cleaning Varies on High-Touch Surfaces Near the Operative Field.

Background: Periprosthetic joint infection may result from pathogen to patient transmission within the environment. The purpose of this study is to evaluate the contamination level of selected high-touch surfaces in the operating room (OR) using a blacklight fluorescent marking system after a manual terminal clean. Methods: Prior to the manual terminal clean, 16 high-touch surfaces were marked using a blacklight fluorescent gel. The marked areas were assessed the next morning for thoroughness of cleaning. Surfaces were categorized based on the average percent of the marks removed as "clean" (>75%), "partially clean" (26%-74%), or poorly cleaned (<25%). This process was repeated randomly 12 times. Terminal cleaning was done in the standard fashion, and the perioperative team was unaware of the initiation of this study. Results: A total of 936 marks were analyzed. There was a significant difference in the number of marks completely clean (29.1%, 272/936) vs marks that were not touched (40.8%, 382/936), P < .001. Only the OR back table (75%) had a rating of clean. Partially clean areas included Mayfield table (72%), overhead lights (70.1%), infusion pump (61.1%), clock reset button (58.3%), table remote control (50%), tourniquet machine (50%), and the OR table (33.3%). Poorly cleaned surfaces included anesthesia medication cart (21.8%), door handles (20.8%), phone (16.7%), electrocautery unit (16.7%), foot pedal (16.7%), anesthesia cart (16.2%), nurses' station (14.1%), and supply cabinet doors (6%). Conclusions: Effectiveness of manual terminal cleaning varied greatly across surfaces. In general, surfaces further from the operative field were less likely to have markings removed.

Use of Cannabis Does Not Decrease Opioid Consumption in Patients Who Underwent Total Joint Arthroplasty.

Background: The primary purpose of this study was to determine if cannabis use decreases narcotic consumption in patients undergoing total joint arthroplasty (TJA). Material and methods: Forty-six patients undergoing a primary unilateral TJA, who self-reported the use of cannabis, were prospectively enrolled and completed this study between July 2015 and November 2019. This cohort was prospectively matched to patients who did not report cannabis use. Morphine equivalents (MEs) were averaged and recorded at 1 and 2 weeks postoperatively. Secondary outcomes and complications were recorded and reported. Results: There were no differences noted in ME during the hospitalization between the user (78.7 ± 58.5) and nonusers (70.4 ± 46.3), P = .455. ME daily average did not differ between the cohorts (user [36.8 ± 30.7] and nonuser [31.7 ± 25.6] at 1 week (P = .389) or user [22.5 ± 26.3] and nonusers [15.9 ± 18.3] at 2 weeks, P = .164, postoperatively). The total ME at 2 weeks did not differ between the user and nonuser groups (415 ± 375 vs 333 ± 275, P = .235). Pain scores at 1 week were significantly higher in patients who used cannabis (4.1 ± 1.9 vs 3.4 ± 1.6, P = .05). No differences in pain were noted during the patient's hospitalization or at 2- (P = .071) or 6-week (P = .111) follow-up. No differences in secondary outcomes or complications were noted. Conclusion: We were unable to show a decrease in narcotic consumption in patients who use cannabis undergoing primary unilateral joint replacement. These findings do not support the routine use of cannabis to decrease or supplement narcotic use after primary TJA. Level of evidence: Level II therapeutic.

A back table ultraviolet light decreases environmental contamination during operative cases.

BACKGROUND: The purpose of this study is to assess the impact of a germicidal ultraviolet light-emitting diode (LED) on the contamination level of a back table in the operating room (OR) during total joint arthroplasty procedures. METHODS: Eight Tryptic Soy Agar petri plates were placed on a table located near the operative field and exposed to air. One plate was removed on the hour over an 8-hour time span. The back table had either an UV-LED for disinfection or a sham UV-LED. This process was repeated in 12 different ORs (6 with UV light, 6 with sham device). The plates were then incubated for 48 hours at 36°C ± 1°C . Colony forming units (CFU) were recorded 24 and 48 hours after incubation. RESULTS: There was a statistically significant difference in total CFUs between the intervention vs sham at 24-hours (27 vs 95, P = .0001) and 48-hours (38 vs 122, P < .0001). The multivariate analysis revealed that the 24-hour and 48-hour count, the predictors UV light (P = .002) and hour of plate removal (P = .050) were statistically significantly associated with CFU counts. Together, the predictor variables explained 15.8% and 23.0% of the variance in CFU counts at 24- and 48-hours, respectively. CONCLUSIONS: A back table UV-LED may decrease environmental contamination near the operative field. This has potential to lead to a decrease in joint infection.

Corrigendum: Self-regulation of time: The importance of time estimation accuracy.

[This corrects the article DOI: 10.3389/fpsyg.2022.925812.].

Supporting Undergraduate Biology Students' Academic Success: Comparing Two Workshop Interventions.

College students' performance in introductory-level biology course work is an important predictor of ongoing persistence in the major. This study reports on a researcher-educator partnership that designed and compared two cocurricular workshops. Seventeen laboratory sections of an undergraduate biology course were randomly assigned to one of two educational interventions during the regularly scheduled lab class section after students had completed and received the results for the first exam. The baseline Metacognition intervention was an hourlong workshop focused on effective learning strategies and self-awareness in the learning process; the extended Metacognition plus Time Management (Metacognition+TM) intervention included the aforementioned workshop plus a second hourlong workshop on time management and procrastination. Based on three exams and self-report surveys administered before the intervention and at the end of the semester, students who participated in the Metacognition+TM intervention experienced greater increases in their exam scores and degree commitment than those in the baseline intervention. Additionally, group status moderated the effect of the intervention, as the Metacognition+TM intervention was especially effective in increasing use of time management tools by students from minoritized groups.

A Prophylactic Tibial Stem Reduces Rates of Early Aseptic Loosening in Patients with Severe Preoperative Varus Deformity in Primary Total Knee Arthroplasty.

BACKGROUND: Patients with a preoperative varus deformity >8 degrees are at increased risk of aseptic loosening after total knee arthroplasty. This study analyzes the effect of a tibial stem on the rate of aseptic loosening in patients with a severe preoperative varus deformity. METHODS: Patients with a preoperative varus deformity of >8 degrees and 2-year minimum follow-up with a stemmed tibial component (n = 67) were matched 1:2 to patients with a similar preoperative varus deformity with a standard tibial component (n = 134). Radiolucent lines were measured on the tibia at 6 weeks, 1 year, and 2 years postoperatively using the Knee Society Radiographic Evaluation System. Failure was defined as revision due to aseptic loosening of the tibial component. Outcomes were evaluated using Student's t-tests and log-rank tests. RESULTS: Patients with tibial stems had greater preoperative deformity (12.9 vs 11.3 degrees, P = .004). There was no difference in postoperative alignment (1.7 vs 2.1 degrees varus, P = .25) or tibial component angle (1.8 vs 2.1 degrees varus, P = .33). Patients with stems were more likely to have more constraint (44.8% vs 1.5%, P < .001). Progression of radiolucent lines >2 mm was observed in 17.6% (23/134) vs 5.97% (4/67) of patients in the stem group (P = .03). Rates of aseptic loosening were lower in the stem group (0% vs 5.15%, P = .05). CONCLUSION: Despite worse preoperative deformity and higher utilization of constraint, tibial stem use in patients with severe preoperative varus deformity resulted in lower rates of aseptic loosening. Prophylactic use of stems in these patients may help increase implant survival.

Alpha-Defensin Is Not Superior to Traditional Diagnostic Methods for Detection of Periprosthetic Joint Infection in Total Hip Arthroplasty and Total Knee Arthroplasty Patients.

BACKGROUND: Synovial fluid alpha-defensin (AD) may improve diagnostic accuracy of periprosthetic joint infection (PJI) following total knee (TKA) and hip (THA) arthroplasty but is only available as send-out test. This study evaluated laboratory result accuracy between send-out test vs hospital labs and if AD made a difference in treatment plan. METHODS: A retrospective review was performed of 152 consecutive patients with a TKA or THA joint aspiration for painful or clinically concerning joint. Synovial fluid was sent to our institution (hospital-based labs, HBL) and send-out immunoassay laboratory (Synovasure). Patients were scored with specific criteria from validated scoring system for PJI using HBL and Synovasure results. The score with and without AD test was compared to determine if AD impacted patient management. RESULTS: Overall, there was strong agreement between institutions for PJI diagnosis (Cohen's kappa score 0.96). Twenty-nine patients had PJI diagnosis (score ≥6), of which 28 (97%) had positive AD with 1 false-negative result. Sixty-three patients had inconclusive score (between 2 and 5) and 60 patients had negative PJI diagnosis (score ≤1). Of these patients, 5 underwent surgery for infection. Two patients had surgery for positive AD, 2 for positive culture, and 1 because of elevated HBL results. The AD test changed the PJI diagnosis and influenced decision for surgery in only 1.3% (2/152) of patients. CONCLUSION: Minimal differences were found in laboratory values between institutions. The addition of AD may be useful in cases of equivocal laboratory results but does not appear to be necessary for routine diagnosis of PJI after TKA/THA. LEVEL EVIDENCE: Level III.

Alpha-Defensin Offers Limited Utility in Routine Workup of Periprosthetic Joint Infection.

BACKGROUND: Alpha-defensin (AD) is a synovial biomarker included as a minor criterion in the scoring system for diagnosing periprosthetic joint infection (PJI). The purpose of this study is to study the impact of AD on diagnosis and management of PJI. METHODS: Synovial fluid from 522 patients after total knee and hip arthroplasty was retrospective reviewed. Synovial white blood cell count, percentage of neutrophils, and culture from the AD immunoassay laboratory were reviewed with serum erythrocyte sedimentation rate and C-reactive protein values from our institution. A modified version of the 2018 scoring system for diagnosis of PJI was used, only scoring white blood cell count, percentage of neutrophils, erythrocyte sedimentation rate, and C-reactive protein. AD was then analyzed with these scores to determine if AD changed diagnostic findings or clinical management. RESULTS: Eight-two patients were categorized as "infected" (score ≥6), of which 76 patients had positive AD. Of the 6 "infected" patients with negative AD, 2 had positive cultures (Staphylococcus epidermidis). Two-hundred thirteen patients were diagnosed as "possibly infected" (score 2-5). Fourteen of these patients had positive AD, of which 5 had positive cultures assisting with the diagnosis. The AD test changed the diagnosis from "possibly infected" to "infected" in 8 patients (1.5%) but only altered treatment plan in 6 patients (1.1%). A score <2 (not infected) was calculated in 227 patients with no patients having positive AD. CONCLUSION: AD may be beneficial in some cases where laboratory values are otherwise equivocal; however, its routine use for the diagnosis of PJI may not be warranted.

Patient Perception Regarding Potential Effectiveness of Cannabis for Pain Management.

BACKGROUND: Self-reported cannabis use has increased since its recent legalization in many states. The primary objective of this study is to describe patients' beliefs regarding the potential effectiveness of cannabis and gauge patient acceptance of these compounds if prescribed by a physician. METHODS: Five hundred fifty-five consecutive new patients in a total joint arthroplasty (TJA) practice completed a questionnaire at their new patient or preoperative encounter. Questions regarding their beliefs about the potential effectiveness of cannabis for pain management were presented to the patient. Each question was scored in accordance to the agreement of the patient. Data were also collected on patient demographics, and current cannabis, tobacco, and/or alcohol use. RESULTS: Current cannabis use was reported in 20.2% (112/555) of respondents. Patients were interested in using cannabis if prescribed by a physician for acute (75.3%, 418/515) and chronic (74.4%, 415/555) pain. Seventy-seven percent (428/555) of patients believe (strongly agree or agree) that cannabis should be legalized for medical use, whereas only 39% (217/555) strongly agree or agree that cannabis should be legalized for recreational use. Patients strongly agree or agree that cannabis can help with sleep or anxiety, 44.9% (249/555) and 49.4% (274/555) respectively. Most patients had never smoked (53%, 294/555) and drink one or less alcoholic beverage per week (52.1%, 299/555). CONCLUSION: Patients believe that cannabis may be helpful for pain management after TJA and are willing to use if prescribed by their orthopedic provider. Further research is warranted to determine if cannabis is a helpful adjunct to pain management in this patient population.