Nonoperative Treatment of Dupuytren's Contracture: The Use of Ultrasound Imaging to Assess Efficacy.

Objective: We have used ultrasound imaging technology to objectively demonstrate changes in the degree and quality of diseased fascia in patients with Dupuytren's disease treated nonoperatively with therapeutic splinting and tissue mobilization. Materials and Methods: Measurement of active proximal interphalangeal and metacarpophalangeal joint extension along with ultrasound elastography imaging of the fascia was performed prior to, and 6 months after, the initiation of therapy. Results: Improvement in active joint extension over the course of therapy was associated with a consistent decrease in the radiologic dimensions of the diseased fascia in combination with qualitative changes in its composition. Conclusion: The use of a simple orthosis and soft tissue mobilization techniques have a quantifiable effect on the degree of deformity and the quantity and quality of contracted fascia in Dupuytren's disease, and would appear to have a role in the management of mild to moderate presentations of the disease when enzymatic or surgical interventions may not be practical.

Pain Management for Periacetabular Osteotomy: A Systematic Review.

Background: Early post-operative pain control is essential to facilitate rapid recovery after orthopaedic surgery. Despite periacetabular osteotomy (PAO) being the gold standard treatment of prearthritic hip dysplasia, there is limited evidence assessing efficacy of early post-operative pain management strategies. Recent literature has focused on non-opioid supplemental treatments such as nerve blocks or local wound infiltration. The purpose of this systematic review was to assess efficacy of these interventions to reduce pain, facilitate mobilization, reduce length of stay after PAO surgery. Methods: A systematic review was created under the guidance of PRISMA from databases that included PubMed, OVID Medline, Embase, SCOPUS, Cochrane Central Register of Clinical Trials, and clinicaltrials.gov from their creation dates to 12/21/23. These studies were screen based on predetermined inclusion and exclusion criteria. Results: A total of six studies were included in this analysis from independent institutions. Three investigated nerve blocks (fascia iliaca, pericapsular, transversus abdominis), one investigated local wound infiltration with ropivacaine, one investigated high-dose dexamethasone, and the last investigated removal of the epidural catheter on postoperative (POD) 1 compared to POD 2. There were heterogeneous outcomes that were measured from these studies. In general, nerve blocks decreased opioid use, pain, and length of hospital stay. The local wound infiltration decreased pain on POD 3 and 4. Removing the epidural catheter on POD1 compared to POD 2 decreased pain and length of stay. High-dose dexamethasone use decreased opioid use on POD 1, otherwise, there was no difference in pain. Conclusion: In summary, supplemental pain management strategies peri-operatively for PAO surgery can decrease pain, opioid use, and length of hospital stay, though there are few studies assessing these interventions. Limiting opioid use after surgery reduces known negative consequences of the medication and facilitates rapid recovery. Clinical trials are needed that assess efficacy of supplemental pain management strategies after PAO surgery. Level of Evidence: II.

The Evolution of Hand Injuries at a State's Only Level I Trauma Center: A Look From the 1980s Through the Global Pandemic.

BACKGROUND: The purpose of this study is to evaluate any changes to hand trauma in the past three decades and through the COVID-19 pandemic. We hypothesized that improved consumer safety regulations, changes in access to care, and the impact of a global pandemic, among other variables, have significantly influenced the mechanisms and treatment of hand injuries between the 1980s, 2010s (pre-COVID-19), and 2020s (post-COVID-19). METHODS: A retrospective single-center review was performed at the only level I trauma center in Mississippi, identifying all hand trauma consultations between 2012-2019 and 2020-2021, compared to aggregated data from 1989. RESULTS: Car accidents, gunshots, saw injuries, door injuries, and falls increased in 2012-2019 and 2020-2021 compared to 1989, whereas knife injuries, glass injuries, industrial injuries, and burns decreased. Crush injuries, de-gloving injuries, and lacerations with irregular edges were increased in recent cohorts, corresponding with increased amputations and tissue loss. Skin and subcutaneous injuries decreased in modern cohorts, corresponding with a decreased ability for primary skin repair and the need for more flaps. Additionally, while hospitalizations have increased, patients have improved follow-up. CONCLUSIONS: The nature of hand trauma has changed significantly over the past three decades. Increased numbers of cars and greater access to firearms might have led to increased rates of high-energy trauma, whereas burn and industrial injuries have decreased, potentially secondary to improved safety efforts. Despite increased overall hand trauma, time to treatment and follow-up have improved. Through this study, we can be more cognizant of the evolution of hand trauma in the modern era. This can allow improved access to care and further refine management to optimize functionality for hand injuries.

Assessment of the comparative agreement between chest radiographs and CT scans in intensive care units.

PURPOSE: Chest radiographs in critically ill patients can be difficult to interpret due to technical and clinical factors. We sought to determine the agreement of chest radiographs and CT scans, and the inter-observer variation of chest radiograph interpretation, in intensive care units (ICUs). METHODS: Chest radiographs and corresponding thoracic computerised tomography (CT) scans (as reference standard) were collected from 45 ICU patients. All radiographs were analysed by 20 doctors (radiology consultants, radiology trainees, ICU consultants, ICU trainees) from 4 different centres, blinded to CT results. Specificity/sensitivity were determined for pleural effusion, lobar collapse and consolidation/atelectasis. Separately, Fleiss' kappa for multiple raters was used to determine inter-observer variation for chest radiographs. RESULTS: The median sensitivity and specificity of chest radiographs for detecting abnormalities seen on CTs scans were 43.2% and 85.9% respectively. Diagnostic sensitivity for pleural effusion was significantly higher among radiology consultants but no specialty/experience distinctions were observed for specificity. Median inter-observer kappa coefficient among assessors was 0.295 ("fair"). CONCLUSIONS: Chest radiographs commonly miss important radiological features in critically ill patients. Inter-observer agreement in chest radiograph interpretation is only "fair". Consultant radiologists are least likely to miss thoracic radiological abnormalities. The consequences of misdiagnosis by chest radiographs remain to be determined.

Tibial polyethylene post fractures at ten-years in a bicruciate stabilised (BCS) total knee arthroplasty design.

INTRODUCTION: This short paper reports a potential emerging mode of failure in three patients with a bicruciate stabilised (BCS) total knee arthroplasty. METHODS: Three patients presented to our institution with late instability ten years after undergoing total knee arthroplasty (Journey BCS) and were asymptomatic up to this point. Retrieval analysis was performed by an external body commissioned by the NHS and all three cases were reported to the UK Medicines and Healthcare Products Regulatory Agency (MHRA). RESULTS: Two patients were revised through simple exchange with a polyethylene tibial insert. One patient underwent a full revision of femoral and tibial components. Intra-operative findings revealed that the polyethylene post had fractured in an identical manner in all three cases. Retrieval analysis demonstrated posterior impingement and wear of the polyethylene post resulting in fatigue failure. CONCLUSIONS: This short paper highlights a potential emerging mode of failure with Journey BCS that requires wider dissemination to raise awareness among surgeons and calls for long-term follow up of those patients who received this specific implant. Early revision with polyethylene exchange is a successful treatment in patients when femoral and tibial components are well-positioned and well-fixed.

Fifteen-year survival analysis of an oxidised zirconium total knee arthroplasty.

BACKGROUND: Early studies have found Oxidised Zirconium (OxZr-Nb) total knee arthroplasties to have a low incidence of failure in young, high demand patients. Theoretically this is because they are low friction and hard wearing. However, there are a paucity of studies reporting on the outcome of these implants beyond ten years. The purpose of our study was to present an in-depth 15-year survival analysis of a cemented OxZr-Nb knee arthroplasty. METHODS: Data was collected prospectively and survival analysis undertaken with multiple strict end-points. Complication rates and patient reported outcomes were measured post-operatively. RESULTS: Six hundred and seventeen knee arthroplasties were analysed. Forty-nine patients required a reoperation for various reasons. Aseptic tibial loosening was the most common cause of failure (32.7%), occurring, on average, 2.8 years after the primary procedure. There was only one oxidised zirconium femoral failure recorded. Cumulative survivorship for reoperation for any reason was 91.52% at 15-years. On average, WOMAC (Western Ontario and McMaster University) score improved by 21.2 points at one-year post-surgery, which is beyond the considered minimum clinically important difference. CONCLUSION: This study presents a 15-year survival analysis of a cemented oxidised zirconium knee arthroplasty showing good survivorship over a range of analyses.

Engineering Enzymes for Environmental Sustainability.

The development and implementation of sustainable catalytic technologies is key to delivering our net-zero targets. Here we review how engineered enzymes, with a focus on those developed using directed evolution, can be deployed to improve the sustainability of numerous processes and help to conserve our environment. Efficient and robust biocatalysts have been engineered to capture carbon dioxide (CO2 ) and have been embedded into new efficient metabolic CO2 fixation pathways. Enzymes have been refined for bioremediation, enhancing their ability to degrade toxic and harmful pollutants. Biocatalytic recycling is gaining momentum, with engineered cutinases and PETases developed for the depolymerization of the abundant plastic, polyethylene terephthalate (PET). Finally, biocatalytic approaches for accessing petroleum-based feedstocks and chemicals are expanding, using optimized enzymes to convert plant biomass into biofuels or other high value products. Through these examples, we hope to illustrate how enzyme engineering and biocatalysis can contribute to the development of cleaner and more efficient chemical industry.

Evaluation of a refugia-based strategy for gastrointestinal nematodes on weight gain and fecal egg counts in naturally infected stocker calves administered combination anthelmintics.

Refugia-based strategies associated with a combination of anthelmintic drugs belonging to different drug classes are becoming more common management practices to mitigate anthelmintic resistance (AR) in gastrointestinal nematodes (GIN) in small ruminants. Though refugia-based strategies have been largely demonstrated in small ruminants, cattle veterinarians and producers are considering such management strategies in grazing cattle production systems. Implementing refugia-based strategies lowers the amount of anthelmintics used in the herd and therefore slows the progression of AR by allowing a proportion of worms to escape drug selection pressure. The objective of this study was to observe the effect of a refugia-based strategy on body weight (BW), average daily gain (ADG) and fecal egg counts (FEC) of trichostongyle-type nematodes in naturally infected beef calves over a 131-day grazing season when compared with a whole herd treatment strategy, using the same combination of drugs. Stocker calves (n = 160) were ranked by body weight within sex then allocated to 16 paddocks, which were randomly assigned to one of two treatment groups. All calves in Group 1 (n = 80) were administered treatment, while in Group 2 (n = 80) the steer with the highest FEC in eggs per gram (EPG) within the paddock was left untreated. Treated calves received an extended release injectable 5 % eprinomectin (LongRange®, Boehringer Ingelheim Animal Health USA Inc.; 1 mL/50 kg of BW) and a 22.5 % oxfendazole oral suspension (Synanthic®, Boehringer Ingelheim Animal Health USA Inc.; 1 mL/50 kg of BW). Fecal egg counts and BW were recorded on days (D) -35, 0, 21, 131, and 148 to calculate the average fecal egg count reduction (FECR) and ADG for both groups. Linear mixed models, with paddock as the experimental unit, were used for analyses. The EPG differed on D21 (p < 0.01) and D131 (p = 0.057) with Group 2 having a higher average FEC (15.2 EPG D21; 57 EPG D131) compared with Group 1 (0.4 EPG D21; 37.25 EPG D131). However, there was no significant difference in average BW or ADG between treatment groups throughout the study. Results suggest refugia-based strategies could be implemented without significant negative impacts on average BW and ADG across other calves in the herd.

Short-Term functional comparison of three total knee arthroplasties-Journey II, Genesis II and Profix.

AIM OF THE STUDY: To compare the outcomes of three knee arthroplasty design philosophies and surface tribology.• A zirconium-surfaced, bicruciate-stabilised implant designed to mimic kinematic movement and improve flexion and outcomes;• A cobalt-chrome surfaced, multi-radius design with built-in femoral external rotation to aid balancing and patella tracking through a deeper trochlea groove;• A zirconium-surfaced, single-radius implant designed on surface conformity, particularly within the patello-femoral joint. METHODS: 313 knee replacements - 103 Journey II, 103 Genesis II and 107 Profix - were statistically assessed at a minimum of 2 years using WOMAC, Oxford and SF-12 scores, and range of movement. RESULTS: There was no difference between the actual or unit change in WOMAC scores (p = 0.140 and p = 0.287), SF-12 physical (p = 0.088) or mental scores (p = 0.975) between the three implants; or between the actual or unit change in Oxford score (p = 0.912 and p = 0.874) for the Journey II or Genesis II. The Journey II produced more flexion and range of movement than the Genesis II (p < 0.001 and p = 0.018) and Profix (p < 0.001 and <0.001) with no difference between the latter two (p = 0.402 and 0.568); with no difference in extension between the three implants (p = 0.086). There was no difference between those with or without a resurfaced patella. CONCLUSION: The three design philosophies and surfaces yielded no difference in outcome scores at 2 years post-operatively. The Journey II demonstrated better post-operative flexion. Resurfacing the patella did not alter the outcome scores or flexion.

Engineering Enzymes for Environmental Sustainability.

The development and implementation of sustainable catalytic technologies is key to delivering our net-zero targets. Here we review how engineered enzymes, with a focus on those developed using directed evolution, can be deployed to improve the sustainability of numerous processes and help to conserve our environment. Efficient and robust biocatalysts have been engineered to capture carbon dioxide (CO2) and have been embedded into new efficient metabolic CO2 fixation pathways. Enzymes have been refined for bioremediation, enhancing their ability to degrade toxic and harmful pollutants. Biocatalytic recycling is gaining momentum, with engineered cutinases and PETases developed for the depolymerization of the abundant plastic, polyethylene terephthalate (PET). Finally, biocatalytic approaches for accessing petroleum-based feedstocks and chemicals are expanding, using optimized enzymes to convert plant biomass into biofuels or other high value products. Through these examples, we hope to illustrate how enzyme engineering and biocatalysis can contribute to the development of cleaner and more efficient chemical industry.

Impact of Global Optimization of Lens Constants on Absolute Prediction Error for Final IOL Power Selection When Using Intraoperative Aberrometry.

Purpose: To evaluate absolute prediction errors following phacoemulsification with implantation of a multifocal toric intraocular lens (IOL) using intraoperative aberrometry for IOL power selection and to compare findings with the globally optimized and manufacturer's recommended lens constants and regression coefficients. Methods: Data from the Optiwave Refractive Analysis (ORA SYSTEM) were analyzed retrospectively. Absolute prediction errors from surgeries performed before and after the first optimization of the manufacturer's recommended lens constant and non-optimized regression coefficients for the multifocal toric IOL (SND1T3-6) were compared. Optimization was based on outcomes of procedures performed using the ORA SYSTEM and archived in its database (AnalyzOR). Outcome measures included the proportion of eyes with absolute ORA SYSTEM prediction errors ≤0.25 D and ≤0.5 D and the mean and median absolute prediction errors. Results: The pre-optimization group included 1027 eyes operated on by 184 surgeons, and the optimized group included 419 eyes operated on by 143 surgeons. The proportions of eyes achieving absolute ORA SYSTEM prediction errors ≤0.25 D (52.5% vs 35.0%, p < 0.0001) and ≤0.50 D (83.1% vs 66.2%, p < 0.0001) were significantly higher in the optimized than in the pre-optimization group. The mean ± standard deviation (0.30 ± 0.25 D vs 0.43 ± 0.32 D, p < 0.0001) and median (0.24 D vs 0.36 D, p < 0.0001) absolute ORA SYSTEM prediction errors were significantly lower after than before optimization. Prediction errors following optimization were reduced more in eyes of average than of long and short axial lengths. Conclusion: Global optimization of the manufacturer's IOL lens constants and regression coefficients resulted in lower absolute prediction errors when compared with the initial manufacturer labeled lens constants and non-optimized regression coefficients. Reductions in absolute prediction error can result in lower postoperative residual refractive error, which can improve post-operative uncorrected visual acuity and provide the potential for greater patient satisfaction following cataract surgery.

Scalp-Mounted Electrical Impedance Tomography of Cerebral Hemodynamics.

An Electrical Impedance Tomography (EIT) system has been developed for dynamic three-dimensional imaging of changes in conductivity distribution in the human head, using scalp-mounted electrodes. We attribute these images to changes in cerebral perfusion. At 100 frames per second (fps), voltage measurement is achieved with full-scale signal-to-noise ratio of 105 dB and common-mode rejection ratio > 90 dB. A novel nonlinear method is presented for 3-D imaging of the difference in conductivity distribution in the head, relative to a reference time. The method achieves much reduced modelling error. It successfully localizes conductivity inclusions in experimental and simulation tests, where previous methods fail. For > 50 human volunteers, the rheoencephalography (REG) waveform is observed in EIT voltage measurements for every volunteer, with peak-to-peak amplitudes up to approx. 50 µVrms. Images are presented of the change in conductivity distribution during the REG/cardiac cycle, at 50 fps, showing maximum local conductivity change of approx. 1% in grey/white matter. A total of 17 tests were performed during short (typically 5s) carotid artery occlusions on 5 volunteers, monitored by Transcranial Doppler ultrasound. From EIT measurements averaged over complete REG/cardiac cycles, 13 occlusion tests showed consistently decreased conductivity of cerebral regions on the occluded side, and increased conductivity on the opposite side. The maximum local conductivity change during occlusion was approx. 20%. The simplicity of the carotid artery intervention provides a striking validation of the scalp-mounted measurement system in imaging cerebral hemodynamics, and the REG images indicate its unique combination of sensitivity and temporal resolution.

The Journey Bicruciate Knee Replacement: Design Modifications Yield Better Early Functional Results and Reduce Complications.

The Journey-I total knee replacement was designed to improve knee kinematics but had several complications including early dislocation. The Journey-II modification was introduced to reduce these while maintaining high function. To assess whether the modified Journey-II prosthesis has succeeded in its designers aims, we undertook an observational study of prospectively recorded data to analyze and compare the two knees. A total of 217 Journey-I and 129 Journey-II knees were identified from the department's prospectively collated registry and were assessed at 1 year by a comparative statistical analysis using numerous factors including pain, functional activity, physical assessment, Short Form-12 (SF-12), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Oxford scores. The statistical tests included Chi-square, Wilcoxon's rank and Mann-Whitney U-tests with the level of significance set at p < 0.05. There was a variation in primary patella resurfacing between the two groups with 14.3% in the Journey-I cohort and 66.7% in the Journey-II cohort. Both replacements demonstrated excellent postoperative function, but the Journey II performed significantly better than Journey I with fewer complications (37 vs. 10) and better improvement in almost all clinical scores including pain (p < 0.01), mobility outcomes (p = 0.018), Oxford (p = 0.004), and WOMAC (p = 0.039) scores but not with flexion improvement and SF-12 score. There was significant improvement in patellofemoral pain postoperatively in both the Journey I (p = 0.011) and Journey II (p = 0.042) arthroplasty; however the primarily resurfaced patella in a Journey-II implant had better postoperative scores. The main complication of dislocation in the Journey I was not seen in the modified Journey-II implant with stiffness requiring intervention reduced in Journey II. These results suggest that the Journey II has improved short-term clinical outcomes compared with Journey I with reduction of dislocation and other complications.

The role of canines in the treatment of posttraumatic stress disorder: A systematic review.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a syndrome of prolonged stress reactions that can develop following a traumatic event. Treatment usually relies on both psychotherapies and pharmacotherapies. Recently, the use of dogs as adjunct intervention for a variety of psychiatric conditions has received widespread attention. The aim of this review was to systematically review the evidence for the use of dogs in the treatment of PTSD. METHOD: A systematic search was conducted using multiple specialist and generalist databases. Articles targeted were those examining the effects of dogs in the treatment of PTSD. Inclusion criteria were peer review, that participants had a formal diagnosis of PTSD, and that the experimental intervention involved a dog. There were no restrictions on subpopulation, exact type or role of dog, or country or language of publication. RESULTS: 16 papers met the inclusion criteria. All of the included studies examined veterans. Methods and results were widely heterogeneous between studies, making it infeasible to quantify an overall effect size. Multiple studies demonstrated promising results when dogs were used as an adjunct intervention to standard therapy, particularly in symptom reduction and social functioning. However, risk of bias was an issue for most of the studies. While the results in most of the studies were overall promising, the risk of biases and veteran subpopulation limit the validity and generalizability of the results. CONCLUSIONS: At best, the current evidence raises the hypothesis that dogs are beneficial in PTSD. Further research is required with a focus on rigorous design. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Siltation negatively affects settlement and gaping behaviour in eastern oysters.

While high levels of siltation are known to be deleterious to eastern oysters (Crassostrea virginica), the collective effect of suspended and bedded sediment is understudied from the perspective of oyster farming and bed restoration. In this study, we used laboratory experiments to explore spat settlement rates on a wild bed proxy substrate (i.e., empty shells on the bottom of experimental tanks) in conditions simulating a siltation event and the presence of suspended spat collectors. Using high-frequency valvometry, we also described the behavioural effects of acute sediment burial on wild adult oysters in situ. The vast majority of larvae settled on bottom substrate as opposed to suspended collectors. Sediment negatively affected overall oyster spat settlement on bottom shell, as spat densities were ≈3 × lower when sediment was present. This negative effect was largely attributed to severely depressed spat densities on the upper side (top) of bottom shells. Settlement on the underside of bottom shell was less affected. Wild adult oyster behaviour was negatively affected by acute burial, which ultimately resulted in death. We suggest that the reduction in settlement in the presence of siltation is likely due to the combined effects of suspended sediment on cue detection and bedded sediment on substrate availability. Given that oysters are ecosystem engineers, the negative effects of siltation on both larval and adult oysters can ultimately result in cascading effects to the surrounding biological community.

Single Use Instruments for Implanting a Contemporary Total Knee Arthroplasty System Are Accurate, Efficient, and Safe.

BACKGROUND: Single use instruments (SUI) is a potential mechanism to improve efficiency and reduce cost in total knee arthroplasty (TKA). New technology requires patient safety and surgical accuracy. A multi-center study of SUI vs reusable mechanical instrumentation (RUI) for a TKA system compared implant placement accuracy and operating room (OR) efficiency. METHODS: Four surgeons implanted 88 primary TKAs, N = 44 RUI and N = 44 SUI. Accuracy was measured radiographically at 3 months. The primary endpoint was non-inferiority of absolute value of mechanical axis alignment. Radiographic endpoints, OR times, and adverse events were also evaluated. RESULTS: Seventy-five subjects completed the study (41 SUI/34 RUI). The primary endpoint non-inferiority of SUI vs RUI was met, with no significant difference between SUI and RUI in most radiographic parameters (distal femoral varus-valgus, proximal tibial varus-valgus, tibial slope, or subjects within 3° of target); there was a slight difference in femoral component flexion angle (P = .015). SUI and RUI mean (SD) OR set-up times were 18.8 (10.03) and 26.7 (6.93) (P <.001), and surgical times (first incision to last stitch) were 64.6 (16.95) and 60.5 (19.01) (P = .295), respectively. Differences in OR clean-down and anesthesia were not significant. There were no revisions, and there was no significant difference in the number of reported adverse events. CONCLUSION: SUI resulted in similar accuracy of implant placement to RUI with decreased OR set-up time and no increase in adverse events. These results support the safety and efficacy of SUI for performing TKA. Further analysis of potential economic and technical advantages is warranted.

Characterising the arthroplasty in spondyloarthropathy in a large cohort of eighty-seven patients with alkaptonuria.

Arthroplasty in the spondyloarthropathy (SPOND) of alkaptonuria (AKU) in incompletely characterised. The aim was to improve the understanding of arthroplasty in AKU through a study of patients attending the National Alkaptonuria Centre (NAC). Eighty-seven patients attended the NAC between 2007 and 2020. Seven only attended once. Fifty-seven attended more than once and received nitisinone 2 mg daily. Twenty-three attended at least twice without receiving nitisinone. Assessments including questionnaire analysis eliciting details of arthroplasty and other surgical treatments for SPOND, 18 FPETCT and CT densitometry at the neck of hip and lumbar spine, as well as photographs of the eyes and ears were acquired from patients attending the National Alkaptonuria Centre (NAC) at baseline when 2 mg nitisinone was commenced, and yearly thereafter. Photographs were scored to derive ochronosis scores. Blood and urine samples were collected for chemical analyses. The prevalence of arthroplasty was 36.8%, similar in males and females, occurring especially in the knees, hips and shoulders. Multiple arthroplasties were found in 29 patients (33.3%) in this cohort. Incident arthroplasty was 6.5% in the nitisinone group and 7.1% in the no-nitisinone group. Incident arthroplasty was 11.3% in the group with baseline arthroplasty and 3.51% in the group without. A strong association of arthroplasty with SPOND (R = 0.5; P << .0001) and ochronosis (R = 0.54; P < .0001) was seen. Nitisinone had no significant effect on incident arthroplasty. Arthroplasty due to ochronosis and SPOND is common in AKU. Nitisinone decreased ochronosis but had no effect on arthroplasty in this cohort.

The Medium-Term Survival Analysis of an All-Polyethylene Tibia in a Single-Series Cohort of Over 1000 Knees.

BACKGROUND: Total knee arthroplasty is a successful elective orthopedic procedure with an increasing number being undertaken. Original knee arthroplasties used an all-polyethylene tibia; however, with concerns over tibial loosening, the trend moved toward the metal-backed variety. Modern designs providing more conformity and changes in manufacturing of the polyethylene make it an equivalent but cheaper option. METHODS: We analyzed the medium-term outcome in 1092 patients with an all-polyethylene tibial component in their total knee arthroplasty. RESULTS: Twenty-six patients had further surgery on their knee for a variety of reasons. Assessing reoperation for any reason, the 7-year survival rate was 96.96% with an overall infection rate of 0.37%. Seven-year survival analysis using aseptic loosening as a criteria was 99.28%. Both the Short Form 12 physical score and Western Ontario and McMaster Universities Osteoarthritis Index score significantly improved and was sustained at 7 years. Body mass did not correlate to either outcomes or complications. CONCLUSION: An all-polyethylene tibia in a total knee arthroplasty has good outcome data and high patient satisfaction with good survivorship in the medium term, coupled with potential cost-saving benefits.