An MRI study demonstrating consistent anatomic relation of central longitudinal artery and associated periosteal vessels with the medial femoral epicondyle and adductor tubercle-A visual landmark method for femoral tunnel placement in medial patellofemoral ligament reconstruction.

The two most common techniques to determine femoral tunnel placement during medial patellofemoral ligament (MPFL) reconstruction are radiographic and by palpation. Their intra/interobserver reliability is widely debated. Both techniques rely on identifying bony landmarks such as the medial epicondyle (ME) and adductor tubercle (AT) during surgery. During MPFL reconstructive surgery, the central longitudinal vessels (CLVs) are seen consistently. The aim of this study was to investigate the anatomic relationship of CLV to ME and AT and to determine if CLV might be used as a landmark during MPFL reconstruction. A retrospective review of MRI scans in skeletally mature patients was undertake. There were two groups, a PFI group that consisted of patients with a diagnosis of patellofemoral instabiliy (PFI) and a non-PFI group that underwent MRI scan for an alternative diagnosis. MRIs were measured for the CLV-ME-AT anatomy and relationship. Following exclusions, 50 patients were identified in each group. The CLV passed anterior to the AT and ME in all patients. ME morphology did not differ greatly between the groups except in the tubercle height, where there was statistically significant but not a clinically important difference (larger in the non-PFI group, 2.95 vs. 2.52 mm, p = 0.002). The CLV to ME tip distance was consistent between the groups (PFI group 3.8 mm and non-PFI group 3.9 mm). The CLV-ME-AT relationship remained consistent irrespective of patients' presenting pathology. The CLV consistently courses anterior to ME and AT. The CLV could be used as a vascular landmark assisting femoral tunnel placement during MPFL reconstruction.

A constrained-condylar fixed-bearing total knee arthroplasty is stabilised by the medial soft tissues.

PURPOSE: Revision constrained-condylar total knee arthroplasty (CCK-TKA) is often used to provide additional mechanical constraint after failure of a primary TKA. However, it is unknown how much this translates to a reliance on soft-tissue support. The aim of this study was therefore to compare the laxity of a native knee to the CCK-TKA implanted state and quantify how medial soft-tissues stabilise the knee following CCK-TKA. METHODS: Ten intact cadaveric knees were tested in a robotic system at 0°, 30°, 60° and 90° flexion with ± 90  N anterior-posterior force, ± 8 Nm varus-valgus and ± 5 Nm internal-external torques. A fixed-bearing CCK-TKA was implanted and the laxity tests were repeated with the soft tissues intact and after sequential cutting. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were sequentially transected and the percentage contributions of each structure to restraining the applied loads were calculated. RESULTS: Implanting a CCK-TKA did not alter anterior-posterior laxity from that of the original native knee, but it significantly decreased internal-external and varus-valgus rotational laxity (p < 0.05). Post CCK-TKA, the sMCL restrained 34% of the tibial displacing load in anterior drawer, 16% in internal rotation, 17% in external rotation and 53% in valgus, across the flexion angles tested. The dMCL restrained 11% of the valgus rotation moment. CONCLUSIONS: With a fully-competent sMCL in-vitro, a fixed-bearing CCK-TKA knee provided more rotational constraint than the native knee. The robotic test data showed that both the soft-tissues and the semi-constrained implant restrained rotational knee laxity. Therefore, in clinical practice, a fixed-bearing CCK-TKA knee could be indicated for use in a knee with lax, less-competent medial soft tissues. LEVEL OF EVIDENCE: Controlled laboratory study.

Improved mediolateral load distribution without adverse laxity pattern in robot-assisted knee arthroplasty compared to a standard manual measured resection technique.

PURPOSE: Robot-assisted total knee arthroplasty (rTKA) remains in its infancy, is expensive but offers the promise of improved kinematic performance through precise bone cuts, with minimal soft tissue disruption, based on pre-resection soft tissue behaviour. This cadaveric study examined load transfer, soft tissue performance and radiographic indices for conventional (sTKA) versus rTKA. The null hypothesis was there would be no difference between the two modes of implantation. METHODS: Whole (ten) cadaveric limbs were randomised to receive either robotic (rTKA, N = 5) or conventional measured resection (sTKA, N = 5) knee arthroplasty. Laxity patterns were established using validated fixed sensors (Verasense) with manual maximum displacement for six degrees of freedom. Tibiofemoral load and contact points were determined dynamically using remote sensor technology for medial and lateral compartments through a functional arc of motion (0-110 degrees of motion). Final component position was assessed using pre- and post-implantation CT. RESULTS: No significant intergroup differences for laxity were found (n.s.). The rTKA group exhibited consistently balanced mediolateral load throughout the full arc with significantly reduced overall total load across the joint (for distinct points of measurement, p < 0.05). Despite using flexion-extension and mediolateral gap balancing with measured resection, the sTKA group failed to achieve balance in at least three points of the flexion arc. Post-operative CT confirmed satisfactory component alignment with no significant differences for positioning between the two groups. CONCLUSION: This work found improved load sharing for rTKA when compared to conventional surgery for same donor knees. Laxity and CT determined final component positioning was not significantly different. The work supports the contention that robot-assisted TKA delivers improved tibiofemoral load sharing in time zero studies under defined conditions but such offers the promise of improved clinical performance and reduced implant wear.

Acute Airway Inflammation Caused By Incomplete Ingestion of Extended-Release Diltiazem: A Case Report.

BACKGROUND: Diltiazem in its extended-release formulation is widely prescribed and is generally well-tolerated. Currently, there are no published case reports of localized inflammation related to extended-release diltiazem causing either significant pill esophagitis or airway inflammation when swallowed incompletely. CASE REPORT: We present a case of an 85-year-old female who reported difficulty swallowing roughly 18 h after incomplete ingestion of an extended-release diltiazem tablet. She had mild stridor and visible right-sided neck swelling on examination. Imaging revealed a large inflammatory mass, which was believed to be a subacute to chronic neoplastic process when reviewed both by radiology and otolaryngology. Two days after presentation, however, the patient's symptoms and the inflammatory mass had resolved entirely. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Extended-release diltiazem can cause an inflammatory mass when ingested incompletely, leading to possible acute airway compromise. Any invasive airway intervention should be approached with caution, given the degree of acute inflammation. Even in patients who do not require intervention, close observation until clinical improvement is warranted in symptomatic patients with a history of recent incomplete ingestion of extended-release diltiazem.

A load-measuring device can achieve fine-tuning of mediolateral load at knee arthroplasty but may lead to a more lax knee state.

PURPOSE: A balanced knee arthroplasty should optimise survivorship and performance. Equilibration of medial and lateral femorotibial load requires guided judicious pericapsular ligament release. The null hypothesis was that there would be no difference between use of a tensiometer device and a remote load sensor final load transfer across the joint through functional arc of motion. METHODS: A cadaveric study, using eight knees, was performed to define the impact of an established gap distraction device against load sensor-aimed soft tissue release in a TKA setting. Using validated measures of laxity in six degrees of freedom and true real-time load sensing four states were examined: native knee, TKA using spacer blocks (TKA), TKA with soft tissue release aided by a monogram tensiometer (TKA-T) and finally where load across the tibiofemoral articulation remains unbalanced final soft tissue release using a sensor device (TKA-OS). RESULTS: The laxity pattern was equivalent for TKA-T and TKA-OS. However, in only four of these seven knees despite the tensiometer confirming equivalence of rectangular flexion-extension gap dimensions and centralisation of collateral ligament distraction, there remained a > 15lb medial to lateral load difference for at least one point of the flexion arc. This was corrected by further final soft tissue release guided by the OS sensor device in the final three knees. CONCLUSION: Tensiometer-guided soft tissue release at two points of flexion failed to achieve balance for three out of seven knee arthroplasty procedures. Sensor technology guided final soft tissue balancing to equilibrate load across the joint through full arc of motion. This work argues for the role of continuous sensor readings to guide the soft tissue balancing during total knee arthroplasty.

Ethylenediurea (EDU) mitigates the negative effects of ozone in rice: Insights into its mode of action.

Monitoring of ozone damage to crops plays an increasingly important role for the food security of many developing countries. Ethylenediurea (EDU) could be a tool to assess ozone damage to vegetation on field scale, but its physiological mode of action remains unclear. This study investigated mechanisms underlying the ozone-protection effect of EDU in controlled chamber experiments. Ozone sensitive and tolerant rice genotypes were exposed to ozone (108 ppb, 7 hr day-1 ) and control conditions. EDU alleviated ozone effects on plant morphology, foliar symptoms, lipid peroxidation, and photosynthetic parameters in sensitive genotypes. Transcriptome profiling by RNA sequencing revealed that thousands of genes responded to ozone in a sensitive variety, but almost none responded to EDU. Significant interactions between ozone and EDU application occurred mostly in ozone responsive genes, in which up-regulation was mitigated by EDU application. Further experiments documented ozone degrading properties of EDU, as well as EDU deposits on leaf surfaces possibly related to surface protection. EDU application did not mitigate the reaction of plants to other abiotic stresses, including iron toxicity, zinc deficiency, and salinity. This study provided evidence that EDU is a surface protectant that specifically mitigates ozone stress without interfering directly with the plants' stress response systems.

High doses of ethylenediurea (EDU) as soil drenches did not increase leaf N content or cause phytotoxicity in willow grown in fertile soil.

Ground-level ozone (O3) levels are nowadays elevated in wide regions of the Earth, causing significant effects on plants that finally lead to suppressed productivity and yield losses. Ethylenediurea (EDU) is a chemical compound which is widely used in research projects as phytoprotectant against O3 injury. The EDU mode of action remains still unclear, while there are indications that EDU may contribute to plants with nitrogen (N) when the soil is poor in N and the plants have relatively small leaf area. To reveal whether the N content of EDU acts as a fertilizer to plants when the soil is not poor in N and the plants have relatively large total plant leaf area, willow plants (Salix sachalinensis Fr. Schm) were exposed to low ambient O3 levels and treated ten times (9-day interval) with 200mL soil drench containing 0, 800 or 1600mg EDU L-1. Fertilizer was added to a nutrient-poor soil, and the plants had an average plant leaf area of 9.1m2 at the beginning of EDU treatments. Indications for EDU-induced hormesis in maximum electron transport rate (Jmax) and ratio of intercellular to ambient CO2 concentration (Ci:Ca) were observed at the end of the experiment. No other EDU-induced effects on leaf greenness and N content, maximum quantum yield of photosystem II (Fv/Fm), gas exchange, growth and matter production suggest that EDU did not act as N fertilizer and did not cause toxicity under these experimental conditions.

Internal femoral component rotation adversely influences load transfer in total knee arthroplasty: a cadaveric navigated study using the Verasense device.

PURPOSE AND HYPOTHESIS: Correct femoral component rotation at knee arthroplasty influences patellar tracking and may determine function at extremes of movement. Additionally, such malrotation may deleteriously influence flexion/extension gap geometry and soft tissue balancing kinematics. Little is known about the effect of subtle rotational change upon load transfer across the tibiofemoral articulation. Our null hypothesis was that femoral component rotation would not influence load across this joint in predictable manner. METHODS: A cadaveric study was performed to examine load transfer using the orthosensor device, respecting laxity patterns in 6° of motion, to examine load across the medial and lateral compartments across a full arc of motion. Mixed-effect modelling allowed for quantification of the effect upon load with internal and external femoral component rotation in relation to a datum in a modern single-radius cruciate-retaining primary knee design. RESULTS: No significant change in maximal laxity was found between different femoral rotational states. Internal rotation of the femoral component resulted in significant increase in medial compartment load transfer for knee flexion including and beyond 60°. External rotation of the femoral component within the limits studied did not influence tibiofemoral load transfer. CONCLUSIONS: Internal rotation of the femoral component will adversely influence medial compartment load transfer and could lead to premature polyethylene wear on the medial side.

Tibiofemoral forces for the native and post-arthroplasty knee: relationship to maximal laxity through a functional arc of motion.

PURPOSE: Accurate soft tissue balance must be achieved to improve functional outcome after total knee arthroplasty (TKA). Sensor-integrated tibial trials have been introduced that allow real-time measurement of tibiofemoral kinematics during TKA. This study examined the interplay between tibiofemoral force and laxity, under defined intraoperative conditions, so as to quantify the kinematic behaviour of the CR femoral single-radius knee. METHODS: TKA was undertaken in eight loaded cadaveric specimens. Computer navigation in combination with sensor data defined laxity and tibiofemoral contact force, respectively, during manual laxity testing. Fixed-effect linear modelling allowed quantification of the effect for flexion angle, direction of movement and TKA implantation upon the knee. RESULTS: An inverse relationship between laxity and contact force was demonstrated. With flexion, laxity increased as contact force decreased under manual stress. Change in laxity was significant beyond 30° for coronal plane laxity and beyond 60° for rotatory laxity (p < 0.01). Rotational stress in mid-flexion demonstrated the greatest mismatch in inter-compartmental forces. Contact point position over the tibial sensor demonstrated paradoxical roll-forward with knee flexion. CONCLUSION: Traditional balancing techniques may not reliably equate to uniform laxity or contact forces across the tibiofemoral joint through a range of flexion and argue for the role of per-operative sensor use to aid final balancing of the knee.

An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty.

PURPOSE: The aim of this study was to quantify the medial soft tissue contributions to stability following constrained condylar (CC) total knee arthroplasty (TKA) and determine whether a medial reconstruction could restore stability to a soft tissue-deficient, CC-TKA knee. METHODS: Eight cadaveric knees were mounted in a robotic system and tested at 0°, 30°, 60°, and 90° of flexion with ±50 N anterior-posterior force, ±8 Nm varus-valgus, and ±5 Nm internal-external torque. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were transected and their relative contributions to stabilising the applied loads were quantified. After complete medial soft tissue transection, a reconstruction using a semitendinosus tendon graft was performed, and the effect on kinematic behaviour under equivocal conditions was measured. RESULTS: In the CC-TKA knee, the sMCL was the major medial restraint in anterior drawer, internal-external, and valgus rotation. No significant differences were found between the rotational laxities of the reconstructed knee to the pre-deficient state for the arc of motion examined. The relative contribution of the reconstruction was higher in valgus rotation at 60° than the sMCL; otherwise, the contribution of the reconstruction was similar to that of the sMCL. CONCLUSION: There is contention whether a CC-TKA can function with medial deficiency or more constraint is required. This work has shown that a CC-TKA may not provide enough stability with an absent sMCL. However, in such cases, combining the CC-TKA with a medial soft tissue reconstruction may be considered as an alternative to a hinged implant.

Does Maximal External Tibial Component Rotation Influence Tibiofemoral Load Distribution in the Primary Knee Arthroplasty Setting: A Comparison of Neutral vs Maximal Anatomical External Rotatory States.

BACKGROUND: Tibial component rotation at time of knee arthroplasty can influence conformity, load transmission across the polyethylene surface, and perhaps ultimately determined survivorship. Optimal tibial component rotation on the cut surface is reliant on standard per operative manual stressing. This subjective assessment aims to balance constraint and stability of the articulation through a full arc of movement. METHODS: Using a cadaveric model, computer navigation and under defined, previously validated loaded conditions mimicking the in vivo setting, the influence of maximal tibial component external rotation compared with the neutral state was examined for changes in laxity and tibiofemoral continuous load using 3D displacement measurement and an orthosensor continuous load sensor implanted within the polyethylene spacer in a simulated single radius total knee arthroplasty. RESULTS: No significant difference was found throughout arc of motion (0-115 degrees of flexion) for maximal varus and/or valgus or rotatory laxity between the 2 states. The neutral state achieved equivalence for mediolateral load distribution at each point of flexion. We have found that external rotation of the tibial component increased medial compartment load in comparison with the neutral position. Compared with the neutral state, external rotation consistently effected a marginal, but not significant reduction in lateral load under similar loading conditions. The effects were most pronounced in midflexion. CONCLUSION: On the basis of these findings, we would advocate for the midtibial tubercle point to determine tibial component rotation and caution against component external rotation.

Analysis of a Medication Safety Intervention in the Pediatric Emergency Department.

Importance: Strategies to reduce medication dosing errors are crucial for improving outcomes. The Medication Education for Dosing Safety (MEDS) intervention, consisting of a simplified handout, dosing syringe, dose demonstration and teach-back, was shown to be effective in the emergency department (ED), but optimal intervention strategies to move it into clinical practice remain to be described. Objective: To describe implementation of MEDS in routine clinical practice and associated outcomes. Design, Setting, and Participants: This mixed-methods interrupted time series study of MEDS was conducted April 2021 to December 2022 in an academic pediatric ED using a hybrid type 1 design. Parents and guardians of children aged 90 days to 11.9 years who were discharged with acetaminophen, ibuprofen, or both were eligible for inclusion in the quantitative portion. Clinicians from a diversity of role groups (attending physician, resident, and nurse) were eligible for the qualitative portion. Exposures: The study was conducted in 5 stages (baseline, intervention 1, washout, intervention 2, and sustainability phases). The 2 intervention phases taught clinical staff the MEDS intervention using different implementation strategies. During the intervention 1 phase, in-depth interviews were conducted until thematic saturation was reached; results were analyzed using thematic analysis. Interviews informed intervention 2 phase interventions. Main Outcomes and Measures: The primary outcome was any error (defined as dosing or frequency error) at a 48- to 72-hour follow-up phone call. Results: There were 256 participants (median [IQR] child age, 1.7 [3.0-7.0] years; median [IQR] parent and guardian age, 36.0 [31.0-41.0] years; 200 females among parents and guardians [78.1%]) who consented and completed follow-up. At baseline, 44 of 68 participants (64.7%) made an error compared with 34 of 65 participants (52.3%) during intervention 1, 31 of 63 participants (49.X%) during intervention 2, and 34 of 60 participants (57.X%) during sustainability. After adjustment for language and health literacy, the adjusted odds ratio for error during the combined intervention phases was 0.52 (95% CI, 0.28-0.97) compared with baseline. Conclusions and Relevance: This study found that both MEDS intervention phases were associated with decreased risk of error and that some improvement was sustained without active intervention. These findings suggest that attempts to develop simplified, brief interventions may be associated with improved medication safety for children after discharge from the ED.

High-Grade Endometrial Cancer: Molecular Subtypes, Current Challenges, and Treatment Options.

Although many recent advancements have been made in women's health, perhaps one of the most neglected areas of research is the diagnosis and treatment of high-grade endometrial cancer (EnCa). The molecular classification of EnCa in concert with histology was a major step forward. The integration of profiling for mismatch repair deficiency and Human Epidermal Growth Factor 2 (HER2) overexpression, can further inform treatment options, especially for drug resistant recurrent disease. Recent early phase trials suggest that regardless of subtype, combination therapy with agents that have distinct mechanisms of action is a fruitful approach to the treatment of high-grade EnCa. Unfortunately, although the importance of diagnosis and treatment of high-grade EnCa is well recognized, it is understudied compared to other gynecologic and breast cancers. There remains a tremendous need to couple molecular profiling and biomarker development with promising treatment options to inform new treatment strategies with higher efficacy and safety for all who suffer from high-grade recurrent EnCa.

"Right now, it's kind of haphazard"-Pediatric emergency care coordinators and quality of emergency care for children: A qualitative study.

Objectives: Pediatric readiness varies widely among emergency departments (EDs). The presence of a pediatric emergency care coordinator (PECC) has been associated with improved pediatric readiness and decreased mortality, but adoption of PECCs has been limited. Our objective was to understand factors associated with PECC implementation in general EDs. Methods: We conducted semistructured qualitative interviews with a purposively sampled set of EDs with and without PECCs. Interviews were completed, transcribed, and coded until thematic saturation was reached. Themes were identified through a consensus process and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Twenty-four interviews were conducted and mapped to themes related to innovation, individuals and implementation process, outer setting (health system), and inner setting (hospital/ED). Addressing innovation, individuals, and implementation process, the primary theme was variability in how the PECC role was defined and who was responsible for implementing it. Regarding the outer setting, participants reported that limited system resources affected their ability to implement the PECC role. Key inner setting themes included concerns about limited visit volume, a lack of systems for measuring pediatric quality of care, and significant tension around change. Conclusions: Implementation of the PECC role appears to be limited by heterogeneous interpretations of the PECC, de-prioritization of pediatrics, and limited system resources. However, many participants described motivation to improve pediatric care and implement the PECC role in context of increasing pediatric visits; they offered strategies for future implementation efforts.

Henry's pelvic deltoid: antiquated concept or important consideration for total hip arthroplasty? An anatomical study.

The relevance of Henry's pelvic deltoid and its contribution to hip abductor strength is often not considered in hip arthroplasty. This small cadaveric study (n = 11) aimed to quantify the relative contributions of the pelvic deltoid muscles to abductor strength and to assess how different surgical approaches(anterolateral, direct lateral and posterior) impact on each of these muscle groups. We inspected the path of each approach and measured the cross-sectional area of the hip abductors, from which the contribution of each muscle to abductor moment was derived. We concluded that the posterior approach has the least impact on the pelvic deltoid and overall abductor moment.

Mapping Oral health and Local Area Resources (MOLAR): protocol for a randomised controlled trial connecting emergency department patients with social and dental resources.

INTRODUCTION: There are substantial inequities in oral health access and outcomes in the USA, including by income and racial and ethnic identity. People with adverse social determinants of health (aSDoH), such as housing or food insecurity, are also more likely to have unmet dental needs. Many patients with dental problems present to the emergency department (ED), where minimal dental care or referral is usually available. Nonetheless, the ED represents an important point of contact to facilitate screening and referral for unmet oral health needs and aSDoH, particularly for patients who may not otherwise have access to care. METHODS AND ANALYSIS: Mapping Oral health and Local Area Resources is a randomised controlled trial enrolling 2049 adult and paediatric ED patients with unmet oral health needs into one of three trial arms: (a) a standard handout of nearby dental and aSDoH resources; (b) a geographically matched listing of aSDoH resources and a search link for identification of geographically matched dental resources; or (c) geographically matched resources along with personalised care navigation. Follow-up at 3, 6, 9 and 12 months will evaluate oral health-related quality of life, linkage to resources and dental treatment, ED visits for dental problems and the association between linkage and neighbourhood resource density. ETHICS AND DISSEMINATION: All sites share a single human subjects review board protocol which has been fully approved by the Mass General Brigham Human Subjects Review Board. Informed consent will be obtained from all adults and adult caregivers, and assent will be obtained from age-appropriate child participants. Results will demonstrate the impact of addressing aSDoH on oral health access and the efficacy of various forms of resource navigation compared with enhanced standard care. Our findings will facilitate sustainable, scalable interventions to identify and address aSDoH in the ED to improve oral health and reduce oral health inequities. TRIAL REGISTRATION NUMBER: NCT05688982.

Risk behaviors among persons civilly committed for opioid use.

Despite the growth in civil commitment for persons who use opioids, we know little about the kinds of risk behaviors among those committed. This study examined the behaviors that a judge might use to determine if there is sufficient evidence that an individual's opioid use poses a risk for serious harm. The study recruited participants (n = 121) from three Massachusetts Department of Public Health civil commitment facilities in 2018. We used a list of risk behaviors that courts consider supportive of opioid-related civil commitment. Participants averaged 28 years of age, 56% were male, and 91% met criteria for severe opioid use disorder. Participants endorsed an average of 9 of the 27 risk behaviors. On average, participants endorsed three of the six drug use behaviors representing a danger to themselves, four of eleven behaviors representing an inability to care for or protect themselves (home safety, weight loss), and two of ten behaviors representing a danger to others (driving high or drunk). Participants who reported they were "not at all pleased" to have been civilly committed endorsed significantly (p = .009) fewer behaviors representing a danger to themselves than those who said they were at least "a little pleased." We conclude that the majority of individuals civilly committed for opioid use are engaging in multiple high-risk behaviors that pose a serious risk of harm to themselves.

Outcome of hip resurfacing in obese patients.

The effect of obesity on outcome for patients undergoing hip resurfacing has been evaluated. Pre and post-operative objective patient scored outcomes for a group of 181 cases of hip resurfacing performed over a three year period were collected. Cases have been stratified by body mass index (BMI) with evaluation of post-operative complications. Patient outcomes included: SF-36, WOMAC, and satisfaction scores, and were compared pre-operatively, and at one year. We found an increased rate of wound complications in the obese group (BMI > 30) with 4 cases of prolonged wound drainage and 2 superficial infections, compared to none in the non-obese group. A similar improvement in SF-36, WOMAC and patient satisfaction was found for both groups. No increase in the risk of femoral neck fracture or aseptic loosening was seen in the obese group. These results suggest excellent early outcomes for obese patients undergoing hip resurfacing with no added risk of early failure.