Risk factors for venous thromboembolism in endometrial cancer.

Background: Venous thromboembolism (vte) in malignancy is associated with poor outcomes. We conducted a retrospective review of vte in patients with endometrial cancer to characterize the vte incidence, identify factors that contribute to vte risk, and compare survival outcomes in patients with and without vte. Methods: A retrospective chart review identified 422 eligible patients who underwent surgery for endometrial cancer (1 January 2014 to 31 July 2016). The primary outcome was vte. Binary logistic regression identified risk factors for vte; significant risk factors were included in a multivariate analysis. Kaplan-Meier estimates are reported, and log rank tests were used to compare the Kaplan-Meier curves. Risk-adjusted estimates for overall survival based on vte were determined using a multivariate Cox proportional hazards model. Results: The incidence of vte was 6.16% overall and 0.7% within 60 days postoperatively. Non-endometrioid histology, stages 3 and 4 disease, laparotomy, and age (p < 0.1) were identified as factors associated with vte and were included in a multivariate analysis. The overall death rate in patients with vte was 42% (9% without vte): hazard ratio, 5.63; 95% confidence interval, 2.86 to 11.08; p < 0.0001. Adjusting for age, stage of disease, and histology, risk of death remained significant for patients with a vte: hazard ratio, 2.20; 95% confidence interval, 1.09 to 4.42; p = 0.0271. Conclusions: A method to identify patients with endometrial cancer who are at high risk for vte is important, given the implications of vte for patient outcomes and the frequency of endometrial cancer diagnoses. Factors identified in our study might assist in the recognition of such patients.

Computer-assisted patellar resection for total knee arthroplasty.

Incorrect patellar resection during total knee arthroplasty can lead to anterior knee pain, patellar maltracking, patellofemoral impingement, patellar fracture, component loosening and reduced range of motion. A computer-assisted surgery (CAS) system was developed to improve the accuracy of the patellar cut. Twelve cadaveric knee specimens (6 pairs) were surgically prepared and the patella resected by two senior orthopaedic residents using either a conventional sawguide technique (right knee) or a computer-assisted sawguide technique (left knee). Multiple cuts and measurements were permitted for the conventional technique, to reflect the clinical situation, whereas only a single cut was permitted for the CAS technique. Prior training had been provided on artificial bones for both techniques. Custom marker arrays were mounted on the sawguide and patella. The user positioned the sawguide based on a real-time display that compared the current sawguide plane to the ideal resection. The resulting mediolateral and superoinferior resection angles and central thickness were measured from CT scans of the specimens, relative to the anterior surface of the patella. Both techniques resulted in symmetric cuts (<7°). Repeatability in the mediolateral direction was better for the CAS technique than for the conventional technique (p<0.01). This study demonstrated that computer-assisted patellar resection is a feasible approach that can produce results equal to or better than those obtained with conventional techniques, even when the experimental conditions favor the conventional technique. Improvements in the CAS hardware could further improve the accuracy and usability of the system, resulting in reductions in postoperative complications. Patellar CAS could also serve as a valuable tool for feedback and training.