Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial.

INTRODUCTION: The use of barbed sutures for wound closure in primary total joint arthroplasty (TJA) has been shown to be effective and safe. However, their effectiveness and safety in revision TJA procedures has not been thoroughly studied. This study aims to evaluate the efficacy and safety of using barbed suture closure in revision TJA setting. METHODS: A total of 80 patients undergoing revision TJA between September 2020 and November 2022 were included in this randomized controlled trial study. Following informed consent, patients were computer-randomized to the treatment arm (barbed suture wound closure) or to the control arm (conventional wound closure). Closure duration, closure rate, number of sutures used and wound related outcomes including complication rates and Patient and Observer Scar Assessment Scale (POSAS) score were compared between groups. RESULTS: The use of barbed sutures decreased closure time by 6 min (30.1 vs. 36.1 min, P = 0.008) with a higher wound closure rate (6.5 vs. 5.5 mm/minute, P = 0.013). Additionally, the number of sutures used for wound closure in the barbed group was significantly lower than in the control group (6.2 vs. 10.1, respectively, P < 0.001). There were no significant differences in the rate of postoperative wound complications (P = 0.556) or patient and observer POSAS scores (P = 0.211, P = 297, respectively) between the two groups at 3-month follow-up. CONCLUSION: Closure of revision TJA surgical wound utilizing barbed sutures reduced closure time and the number of needles handled by operative staff, with no significant increase in intra- or post-operative complications rate when compared to traditional closure technique. LEVEL OF EVIDENCE: I.

The impact of eye gaze on social interactions of females in virtual reality: The mediating role of the uncanniness of avatars and the moderating role of task type.

The introduction of the Metaverse and the rise of social virtual reality platforms such as VRChat has led to increased communication and collaboration in virtual reality. As interactions in social virtual reality take place through avatars, the behaviour, and in particular the eye gaze of an avatar can have an impact on the user experience. However, it is still unclear which features of the user experience are most influenced. Therefore, this study used data from 44 female participants to investigate how avatar gaze behaviour (static eyes vs. real-time tracked eyes) affects their perceived quality of communication and the amount of one-sided eye contact participants make during a communicative or collaborative task in virtual reality. In addition, the study investigated the mediating role of perceived avatar "uncanniness" (i.e., the finding that humanoid objects that imperfectly resemble real people evoke feelings of discomfort) in this relationship and the moderation effect of two multi-user scenarios (collaboration vs. communication). The results showed that uncanniness directly affected the perceived quality of communication. However, it did not significantly mediate the relationship between avatar eye gaze behaviour and the quality of communication or the amount of one-sided eye contact. Finally, there were no significant differences in user experience between the two scenarios. From this, we can conclude that the uncanniness of an avatar being interacted with in VR is not enough to hinder communication and collaboration in an immersive medium. And even if an avatar is perceived as uncanny, normative communication cues such as eye contact are still present. Notably, due to sample availability, the results of this study are based on a female-only sample. Thus, future research can benefit from exploring the outlined effects in a more gender-balanced sample.

Preoperative Patient Expectation of Discharge Planning is an Essential Component in Total Knee Arthroplasty.

PURPOSE: A better understanding of total knee arthroplasty (TKA) candidate expectations within the perioperative setting will enable clinicians to promote patient-centered practices, optimize recovery times, and enhance quality metrics. In the current study, TKA candidates were surveyed pre- and postoperatively to elucidate the relationship between patient expectations and length of stay (LOS). MATERIAL AND METHODS: This is a prospective study of patients undergoing TKA between December 2017 and August 2018. Patients were electronically administered surveys regarding their discharge plan 10 days pre-/postoperatively. All patients were categorized into three cohorts based on their LOS: 1, 2, and 3+ days. The effect of preoperative discharge education on patient postoperative satisfaction was evaluated. RESULTS: In total, 221 TKAs were included, of which 83 were discharged on postoperative day (POD) 1, 96 on POD-2, and 42 POD-3+. Female gender, increasing body mass index (BMI), and surgical time correlated with increased LOS. Preoperative discussions regarding LOS occurred in 84.62% (187/221) of patients but did correlate with differences in LOS. However, patients discharged on POD-1 were more inclined to same-day surgery preoperatively. Patients discharged on POD-3+ were found to be more uncomfortable regarding their discharge during the preoperative phase. Multivariable regressions demonstrated that preoperative discharge discussion was positively correlated with home discharge. CONCLUSION: Physician-driven discussion regarding patient discharge did not alter patient satisfaction or length of stay but did correlate with improved odds of home discharge. These findings underscore the importance of patient education, shared decision-making, and managing patient expectations.

Danger, high voltage! Using EEG and EOG measurements for cognitive overload detection in a simulated industrial context.

Industrial settings will be characterized by far-reaching production automation brought about by advancements in robotics and artificial intelligence. As a consequence, human assembly workers will need to adapt quickly to new and more complex assembly procedures, which are most likely to increase cognitive workload, or potentially induce overload. Measurement and optimization protocols need to be developed in order to be able to monitor workers' cognitive load. Previous studies have used electroencephalographic (EEG, measuring brain activity) and electrooculographic (EOG, measuring eye movements) signals, using basic computer-based static tasks and without creating an experience of overload. In this study, EEG and EOG data was collected of 46 participants performing an ecologically valid assembly task while inducing three levels of cognitive load (low, high and overload). The lower individual alpha frequency (IAF) was identified as a promising marker for discriminating between different levels of cognitive load and overload.

Cemented Stems in Total Hip Arthroplasty What is Old and What is New Again?

Cement fixation of the femoral stem in total hip arthroplasty, first popularized in the 1960s following the success of Sir John Charnley's design, remains a prevalent topic in arthroplasty literature today. Though this technique is still widely used among European surgeons, since the 1980s many American surgeons have shifted to the use of cementless, press-fit stems except for particular cases such as those at increased risk for periprosthetic fracture. In this article we review the history and literature regarding the use of cemented stems in total hip arthroplasty in the United States and Europe over the past 70 years.

Principles of a 3D printed mechanical device for total knee balancing.

Implant alignment and soft-tissue balancing are important factors in total knee arthroplasty (TKA). The purpose of this study was to design a mechanical balancing device, which measures deflections resulting from forces applied on each condyle to provide numerical data indicating the extent of ligament release needed, or angular changes in the bone cuts required to achieve a balanced knee. Two mechanical devices were designed and 3D printed, Pistol Grip and In-line. The Pistol Grip design consisted of a lever system that indicated the difference between lateral and medial forces with a single pointer. The In-line design allows for the quantification of the absolute force applied on each individual condyle. The two designs were evaluated on a test rig designed to model balance and imbalance conditions in the knee. For the Pistol Grip design maximum pointer deflection indicates a 2 mm change in elevation per condyle and/or a 3 degrees angular change of the condyles which can be corrected by adjusting the ligament lengths equivalent to 2 mm and/or by modifying the proximal or distal femur bone cut by 3 degrees. For the In-line design, maximum pointer deflection represented a 40 N load on the condyle. Our mechanical balancer designs were successful in providing information that can guide surgeons to accurately achieve balance through ligamentous releases and/or modification to bone cuts. The balancer designs are easy to use, do not require any electronics or software, and can be incorporated into the surgical procedure.

Thirty-Day Outcomes After Bilateral Total Hip Arthroplasty in a Nationwide Cohort.

BACKGROUND: Approximately 42% of patients with end-stage osteoarthritis have bilateral disease. Although bilateral total hip arthroplasty (THA) is physiologically demanding, certain patients may benefit from simultaneous rather than staged bilateral procedures. This study examines the intraoperative differences and 30-day outcomes in patients receiving bilateral THA compared with those who underwent unilateral THA. METHODS: Patients undergoing THA were selected from the National Surgical Quality Improvement Program database from 2008 to 2015. Patients were selected according to those with primary and concurrent coding for Current Procedural Terminology 27130. Thirty-day complications were recorded, and multivariate analyses were performed to determine whether concurrent THA was a risk factor for poor outcomes. RESULTS: A total of 97,804 patients and 587 patients who underwent unilateral and bilateral THA, respectively, were identified. Patients who underwent bilateral procedures were younger (57.3 vs 64.6 years, P < .001), were of lower body mass index (29.2 vs 30.2, P < .001), and had fewer comorbidities than patients who underwent unilateral procedures. Length of stay was not increased for bilateral recipients (3.13 vs 2.93 days, P = .308), although fewer were discharged to home (62.8% vs 77.6%, P < .001). The bilateral recipients required postoperative transfusions at a higher rate (29.8% vs 10.9%, P < .001) and had an increased incidence of deep wound infections on univariate analysis (1.2% vs 0.3%, P = .002). There was no increased risk of superficial infection, medical complications, or thromboembolic events for the bilateral cohort. CONCLUSIONS: Although bilateral THA recipients are younger with fewer preoperative comorbidities, bilateral THA is associated with an increased rate of transfusion in a nationwide setting. With this knowledge, specific interventions should be instituted to target these procedure-specific risks.

The Hip-Spine Relationship Simplified.

Much attention has recently been focused on the relationship between the hip and spine and its contribution to postoperative instability following total hip arthroplasty. However, the terminology can be confusing. Through an understanding of spinopelvic parameters, spinopelvic motion, and the interplay between the spine and pelvis, the surgeon can plan for and decrease the risk of instability after total hip arthroplasty. This review details spinopelvic parameters that predispose to instability and guides readers in understanding spinopelvic motion as it relates to THA instability.

PT Achievement in Public Hospitals and Its Effect on Outcomes.

The demand for TKA continues to rise within the United States, while increasing quality measures and cost containment became the basis of reimbursement for hospital systems. Length of stay is a major driver in the cost of TKA. Early mobilization with physical therapy has been shown to increase range of motion and decrease complications, but with mixed results in regards to length of stay. We postulate that initiating physical therapy on post-operative day zero will decrease length of stay in an urban public hospital. Retrospective chart review was performed at a large, urban, public academic medical center to identify patients who have had a primary TKA over the course of a 3-year period. Groups who underwent post-operative day zero therapy were compared with those who initiated physical therapy on post-operative day one. Length of stay was the primary outcome. Patient demographic characteristics and discharge disposition were also collected. There were 98 patients in the post-operative day-one physical therapy cohort and 58 in the post-operative day zero physical therapy group. Hospital length of stay was significantly decreased in the post-operative day zero physical therapy group. (p < 0.01) There was no difference in discharge disposition between the two groups.

Brief Report: Changes in Levels of Inflammation After Antiretroviral Treatment During Early HIV Infection in AIDS Clinical Trials Group Study A5217.

BACKGROUND: We evaluated the changes in the levels of soluble biomarkers of inflammation and coagulation and T-cell activation among participants of AIDS Clinical Trials Group Study A5217 who were started on antiretroviral therapy (ART) within the first 6 months of HIV infection. METHODS: Cryopreserved specimens were obtained pre-ART (week 0), at the time of virologic suppression (week 36), and at 36 weeks after treatment interruption (week 72). Levels of D-dimer, C-reactive protein (CRP), and soluble CD14 (sCD14) were measured in plasma, whereas T-cell activation levels, defined as the frequencies of CD4 and CD8 T cells coexpressing HLA-DR and CD38, were measured in peripheral blood mononuclear cells. RESULTS: D-dimer levels were significantly lower at viral suppression (P = 0.031), whereas CRP and sCD14 levels remained similar to pre-ART levels. At viral suppression, levels of the soluble markers did not correlate with each other. CD4 T-cell counts pre-ART tended to modestly correlate with levels of D-dimer (r = 0.35; P = 0.058) and CRP (r = 0.33; P = 0.078). At 36 weeks after treatment interruption (week 72), D-dimer levels returned back to pre-ART levels. However, CD8 T-cell activation was significantly lower than pre-ART levels (35.8% at week 0 vs 28.9% at week 72; P = 0.004). CONCLUSIONS: Among the A5217 participants who started ART within the first 6 months of HIV infection, high levels of sCD14 and CRP remain similar to pre-ART levels, suggesting that immune damage occurring in the initial stages of infection persists despite short-term virologic suppression.

Spontaneous retroperitoneal hemorrhage in a dialysis patient.

BACKGROUND: Patients with end-stage renal disease (ESRD) often present to the Emergency Department with a multitude of complaints. Abnormal vital signs and a chief complaint of pain can produce a diagnosis ranging from a cardiac etiology to an infectious source. OBJECTIVES: Our goal is to discuss a case in which an ESRD dialysis patient presented with a rare, life-threatening emergency. CASE REPORT: A 55-year-old man with ESRD presented with acute abdominal pain and hypotension caused by a spontaneous retroperitoneal hemorrhage. CONCLUSION: This case report demonstrates the necessity of having broad differential diagnoses when evaluating patients with ESRD.

Perceived environments as physical activity correlates and moderators of intervention in five studies.

PURPOSE: Few studies have explored how relationships of perceived environment and physical activity vary across different activity domains and populations. This question was explored in five physical activity intervention trials funded by the National Institutes of Health Behavior Change Consortium. DESIGN: Observational. SETTINGS: San Francisco peninsula, California (N = 94); Eugene, Oregon (N = 122); Atlanta, Georgia (N = 256); Kingston, Rhode Island (N = 109); Memphis, Tennessee (N = 64). SUBJECTS: Ethnically diverse community adults ages 18 to 85 years. MEASURES: The Neighborhood Environment Walkability Scale and CHAMPS physical activity questionnaire. Response rate among those invited to complete these measures was 90%. RESULTS: Cross-sectional pooled signal detection analysis indicated that people who reported living in neighborhoods with more attractive scenery and ease of walking were more likely to meet national physical activity recommendations (67%) compared with those without these neighborhood attributes (36%; chi2 = 13.04, p = .0003). Within-site multiple regression identified two additional variables--seeing others when walking and encountering loose dogs that make it difficult to walk--as correlates across multiple sites and activity domains (i.e., minutes of weekly moderate or more vigorous activity, walking for errands, walking leisurely) (incremental R2 = 2.0-7.5; p < .05). Analyses of covariance suggested that traffic safety might be particularly important in facilitating or impeding physical activity in response to a formal intervention (for traffic-arm assignment interactions, F = 3.8-7.0, p < or = .05). CONCLUSIONS: Relationships between perceived environments and physical activity may differ depending upon population groups and activity domains and merit investigation by using stronger prospective designs.

Retrospective evaluation of shoreline water quality along Santa Monica Bay beaches.

Santa Monica Bay (SMB) beaches are the most heavily used in the U.S.A., despite an increased number of water quality postings over the last several years. To assess whether water quality problems are concentrated at a small number of chronically affected sites or whether the problems are widely distributed, we compiled 5 years of monitoring data collected at 59 sites, 22 of which are sampled daily. Other locally available rainfall and sewage spill monitoring information data were added to this data set to assess whether sewage spills, dry-weather runoff, or wet-weather runoff contribute the most to exceedences of water quality thresholds. Approximately 13% of the shoreline mile-days along monitored beaches in SMB exceeded the State of California's beach water quality standards during the 5-year study period. Most of the water quality exceedences occurred near urban runoff drains even though areas affected by drains represent only a small portion of the total shoreline. Although storms are relatively infrequent in southern California, the extent of water quality exceedences resulting from storm water runoff was similar to the extent of water quality exceedences found during dry weather. Sewage spills, while potentially more serious because they lead to beach closures rather than to the more limited posting of warning signs, represented less than 0.1% of the shoreline mile-days that exceeded water quality thresholds. During dry weather conditions, most of the water quality problems occurred near five of the largest drains and at two beach areas that have unique physical characteristics, which limited mixing, dispersion, and dilution. During wet weather conditions, water quality problems were more widespread.