The impact of nonoperative hip and core injuries on National Football League athlete performance.

OBJECTIVES: Hip and core injuries are common in National Football League (NFL) athletes; however, the impact following injury remains unclear. The goal of this manuscript was to determine the impact of nonoperative hip and core injuries on return to play and performance. METHODS: NFL athletes who sustained a hip or core injury treated nonoperatively between 2010 and 2016 were identified. Offensive and defensive power ratings were calculated for each player's injury season and two seasons before and after to assess longitudinal impact. A matched control group without an identified hip and/or core injury was assembled for comparison. RESULTS: A total of 41 offensive and 71 defensive players with nonoperative hip or core injury were analyzed. All athletes returned to play; offensive and defensive players missed 4.0 ± 5.2 and 3.1 ± 2.6 games after injury, respectively. Offensive players played fewer cumulative career games returning from core injury versus hip (23.5 ± 20.6 vs 41.0 ± 26.4). Defensive players played fewer games (58.1 ± 41.1 versus 37.4 ± 27.1, p < 0.05) with lower defensive power rating (133.9 ± 128.5 versus 219.8 ± 212.2, p < 0.05) cumulatively after hip or core injury. Additionally, 2 years following injury, defensive players played fewer games compared to controls (9.5 ± 7.0 versus 10.9 ± 6.8, p < 0.05). Following hip injury specifically, NFL defenders played fewer games (39.8 ± 27.9 vs 61.9 ± 38.8; p < 0.05) and had a lower defensive power rating (145.9 ± 131.7 vs 239.0 ± 205.9; p < 0.05) compared to before injury. CONCLUSION: Overall, NFL players return to play following nonoperative hip and core injuries. Defensive players played in fewer games following hip or core injury compared to controls; offensive players were unaffected. Hip injuries have a greater impact on performance compared to core injuries in defensive athletes; offensive players played fewer games upon return from core injury.

Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA.

BACKGROUND: Robotic-assisted total knee arthroplasty (TKA) is a growing technique in adult reconstruction. The variations between robotic-assisted and conventional TKA could lead to changes in immediate postoperative outcomes. We aimed to evaluate for differences in postoperative pain, discharge day, as well as post-hospital disposition (home vs subacute rehabilitation facility [SAR]) between robotic-assisted and conventional TKA. METHODS: We retrospectively identified 2 cohorts of patients who underwent either conventional or robotic-assisted TKA between January 2019 and July 2019. Their average pain scores from postoperative day 0, day 1, and day 2 were recorded. Their postoperative discharge day was recorded, as well as their disposition to either home or a SAR. Preoperatively, all patients are offered robotic-assisted TKA, and only those who want the procedure and undergo a preoperative CT scan receive the robotic-assisted surgery. Statistical analysis was conducted using SPSS. RESULTS: One hundred sixty-six patients were identified with 83 in each cohort. No differences between age, race, and gender were found. Despite minor variations in pain levels, the overall postoperative pain score analysis did not strongly favor one technique over the other. The robotic-assisted group had a significantly higher amount of patients discharged to home instead of a SAR and also had a shorter time to discharge than the conventional group. CONCLUSIONS: Robotic-assisted TKA has similar postoperative pain scores compared with conventional TKA. The robotic-assisted cohort demonstrated other benefits including earlier discharge and are more likely to be discharged home instead of a SAR.

Investigation of ventriculoperitoneal shunt disconnection for hydrocephalus treatment.

OBJECTIVE: This investigation is aimed at gaining a better understanding of the factors that lead to mechanical failure of shunts used for the treatment of hydrocephalus, including shunt catheter-valve disconnection and shunt catheter fracture. METHODS: To determine the root cause of mechanical failure, the authors created a benchtop mechanical model to mimic mechanical stressors on a shunt system. To test shunt fracture, cyclical loading on the catheter-valve connection site was tested with the shunt catheter held perpendicular to the valve. Standard methods were used to secure the catheter and valves with Nurolon. These commercial systems were compared to integrated catheters and valves (manufactured as one unit). To test complete separation/disconnection of the shunt catheter and valve, a parallel displacement test was conducted using both Nurolon and silk sutures. Finally, the stiffness of the catheters was assessed. All mechanical investigations were conducted on shunts from two major shunt companies, assigned as either company A or company B. RESULTS: Cyclical loading experiments found that shunts from company B fractured after a mean of 4936 ± 1725 cycles (95% CI 2990-6890 cycles), while those of company A had not failed after 8000 cycles. The study of parallel displacement indicated complete disconnection of company B's shunt catheter-valve combination using Nurolon sutures after being stretched an average 32 ± 5.68 mm (95% CI 25.6-38.4 mm), whereas company A's did not separate using either silk or Nurolon sutures. During the stiffness experiments, the catheters of company B had statistically significantly higher stiffness of 13.23 ± 0.15 N compared to those of company A, with 6.16 ± 0.29 N (p < 0.001). CONCLUSIONS: Mechanical shunt failure from shunt catheter-valve disconnection or fracture is a significant cause of shunt failure. This study demonstrates, for the first time, a correlation between shunt catheters that are less mechanically stiff and those that are less likely to disconnect from the valve when outstretched and are also less likely to tear when held at an angle from the valve outlet. The authors propose an intervention to the standard of care wherein less stiff catheters are trialed to reduce disconnection.

Comorbidity of diabetes mellitus in idiopathic normal pressure hydrocephalus: a systematic literature review.

Idiopathic normal pressure hydrocephalus (iNPH) is a subtype of hydrocephalus that occurs more often in the elderly population. It is usually characterized by gait disturbance, dementia and urinary incontinence. Epidemiological studies indicate that 15.7-17.8% of iNPH patients present with type-2 diabetes mellitus (DM). A review of the primary literature shows that these occurrence rates are higher than age- and cohort-matched non-iNPH controls. This suggests that this already vulnerable patient group has an increased risk for presenting with DM compared to their non-iNPH counterparts. Postoperative outcome when treating iNPH patients is inversely related to the number of patient comorbidities and a lower comorbidity status is correlated with better outcomes. This review highlights the need for further research into the relationship between iNPH and DM and speculates on a possible mechanism for an association between the development of ventriculomegaly and the development of DM and iNPH.