Effectiveness and safety profile of greater occipital nerve blockade in cluster headache: a systematic review.

BACKGROUND: Greater occipital nerve (GON) blockade is a short-term preventive therapy for cluster headache (CH). We conducted a systematic review to evaluate the effectiveness and safety of GON blockade in patients with CH. METHODS: On 23 October 2020, we searched MEDLINE, Embase, Embase Classic, PsycINFO, CINAHL, CENTRAL and Web of Science databases from their inception date. Studies included participants with a CH diagnosis who received corticosteroid and local anaesthetic suboccipital region injections. Outcomes were change in the frequency/severity/duration of attacks; proportion of participants responding to treatment, time to attack freedom from an attack, change in attack bout length and/or the presence of adverse effects after GON blockade. Risk of bias was assessed with the Cochrane Risk of Bias V.2.0 (RoB2)/Risk of Bias in Non-randomized Studies - of Interventions (ROBINS- I) tools and a specific tool for case reports/series. RESULTS: Two RCTs, eight prospective and eight retrospective studies, and four case reports were included in the narrative synthesis. Every effectiveness study found a significant response in one or more of frequency/severity/duration of individual attacks or proportion of patients responding to treatment (47.8%-100.0%). There were five instances of potentially irreversible adverse effects. A higher injectate volume and use of concurrent prophylaxis may be associated with an increased likelihood of response. Methylprednisolone may have the best safety profile of available corticosteroids. DISCUSSION: GON blockade is safe and effective for CH prevention. Higher injectate volumes may improve likelihood of response, and the likelihood of serious adverse events may be reduced by using methylprednisolone. PROSPERO REGISTRATION NUMBER: CRD42020208435.

Achieving a Balanced Knee in Robotic TKA.

Total knee arthroplasty (TKA) surgery with manual instruments provides a quantitatively balanced knee in approximately 50% of cases. This study examined the effect of combining robotics technology with real-time intra-operative sensor feedback on the number of quantitatively balanced cases in a consecutive series of 200 robotic-assisted primary TKAs. The robotics platform was used to plan the implant component position using correctable poses in extension and a manual, centrally pivoting the balancer in flexion, prior to committing to the femoral cuts. During the initial trialing, the quantitative state of balance was assessed using an instrumented tibial tray that measured the intra-articular loads in the medial and lateral compartments. These sensor readings informed a number of surgical corrections, including bone recuts, soft-tissue corrections, and cement adjustments. During initial trialing, a quantitatively balanced knee was achieved in only 65% of cases. After performing the relevant soft-tissue corrections, bone recuts, and cement adjustments, 87% of cases ended balanced through the range of motion. Meanwhile, this resulted in a wide range of coronal alignment conditions, ranging from 6° valgus to 9° varus. It is therefore concluded that gaps derived from robotics navigation are not indicative for a quantitatively balanced knee, which was only consistently achieved when combining the robotics platform with real-time feedback from intra-operative load sensors.

Early-life stress is associated with a preponderance of habitual responding in a novel instrumental avoidance learning paradigm.

There is substantial evidence linking early-life stress (ELS) to negative health outcomes in adulthood, including addiction. However, the neurocognitive and behavioral mechanisms through which ELS increases these risks remain unclear. To address this gap in knowledge, we developed a novel instrumental learning paradigm to explore the effects of ELS on the balance of habitual versus goal-directed learning. Habits efficiently reproduce repetitive behaviors but are inflexible whenreward contingencies related to those behaviors change. Persisting in performing a response after its outcome has been devalued is the hallmark of habitual behavior in instrumental learning. Participants with a history of higher ELS were significantly more likely to make habitual responses in this instrumental avoidance learning paradigm than individuals with a history of lower ELS. Logistic regression analysis showed that ELS is significantly related to habitual responding over and above the effects of retrospective socioeconomic status, trait and state anxiety, depression and recent levels of stress. Analysis of the differential impacts of the type of ELS suggested that these effects are largely driven by experiences of physical neglect.

Clinical Utility of the Personality Assessment Inventory in Predicting Symptom Change and Clinical Outcome in an Inpatient Chemical Dependency Rehabilitation Unit.

Newly admitted inpatients in a 28-day chemical dependency rehabilitation unit completed the Personality Assessment Inventory (PAI) at admission and measures of clinical symptomatology (Symptom Checklist-90-Revised) and clinical outcome (Schwartz Outcome Scale-10) at admission and discharge. PAI drug and alcohol scale scores were clinically elevated in this inpatient sample. Modest elevations were found on scales measuring stress, depression, and antisocial and borderline features. Lower scores on most PAI clinical scales were associated with greater symptom reduction and improved psychological well-being, while controlling for pretreatment levels. Multivariate analysis controlling for contributions of clinical scales measuring borderline, depressive, and antisocial traits, as well as pretreatment outcome measures, demonstrated that the PAI Suicidal Ideation and Treatment Rejection scales were significant individual predictors of symptom reduction and improved psychological well-being, respectively, although the treatment scales as a group failed to incrementally contribute to prediction. Overall, the results support the clinical utility of using the PAI to predict clinical improvement among inpatients treated for substance use disorders.

Does It Matter: Total Hip Arthroplasty or Lumbar Spinal Fusion First? Preoperative Sagittal Spinopelvic Measurements Guide Patient-Specific Surgical Strategies in Patients Requiring Both.

BACKGROUND: In patients requiring both total hip arthroplasty (THA) and lumbar spinal fusion (LSF), consideration of preoperative sagittal spinopelvic measurements can aid in the prediction of postfusion compensatory changes in pelvic tilt (PT) and inform adjustments to traditional THA cup anteversion. This study aims to identify relationships between spinopelvic measurements and post-THA hip instability and to determine if procedure order reveals a difference in hip dislocation rate. METHODS: Patients at a single practice site who received both THA and LSF between 2005 and 2015 (292: 158 = LSF prior to THA, 134 = THA prior to LSF) were retrospectively reviewed for incidents of THA instability. Those with complete radiograph series (89) had their sagittal (standing) spinopelvic profiles measured preoperatively, immediately postoperatively, and 3 months, 6 months, 1 year, 1.5 years, and 2 years postoperatively. Measured parameters included lumbar lordosis (LL), pelvic incidence (PI), PT, and sacral slope (SS). RESULTS: No significant differences in dislocation rates between operative order groups were elicited (7/73 LSF first, 4/62 THA first; Z = 0.664, P = .509). Compared to nondislocators, dislocators had lower LL (-10.9) and SS (-7.8), and higher PT (+4.3) and PI-LL (+7.3). Additional risk factors for dislocation included sacral fusion (relative risk [RR] = 3.0) and revision fusion (RR = 2.7) . Predictive power of the model generated through multiple regression to characterize individual profiles of post-LSF PT compensation based on perioperative measurements was most significant at 1 year (R2 = 0.565, F = 0.000456, P = .028) and 2 years (R2 = 0.741, F = 0.031, P = .001) postoperatively. CONCLUSION: In performing THA after LSF, it is theoretically ideal to proceed with THA at a postfusion interval of at least 1 year, beyond which further compensatory PT change is minimal. However, the order of surgical procedure revealed no statistical difference in hip instability rates. In cases characterized by large PI-LL mismatch (larger or less predictable compensation profiles) or large SS or LL loss (considerably atypical muscle recruitment), consideration of full functional anteversion range between sitting and standing positions to account for abnormalities not appreciated with standing radiographic assessment alone may be warranted.

Are Patients More Satisfied With a Balanced Total Knee Arthroplasty?

BACKGROUND: Patient-reported outcome measures are increasingly recognized as an important tool in quantifying the clinical success of arthroplasty surgery. The aim of this study is to measure post-operative joint awareness and satisfaction in patients with and without a quantitatively balanced knee following primary total knee arthroplasty (TKA). METHODS: In this multi-center study, a total of 318 eligible patients were assigned to one of the 2 patient groups: sensor-guided TKA or surgeon-guided TKA. In the sensor-guided group, quantitative balancing was performed according to intercompartmental tibiofemoral load measurements measured by an instrumented tibial trial component. In contrast, for the surgeon-guided group, the knees were balanced according to the surgeons' standard manual techniques while blinding the surgeon to the sensor measurements. Patients were blinded to their allocation and filled out the validated Forgotten Joint Score and 2011 Knee Society Satisfaction questionnaires at 6 weeks and 6 months. For the purposes of this study, the subjects were pooled and stratified by their state of soft tissue balance, based on the mediolateral load differential through the range of motion. RESULTS: In the surgeon-guided group, approximately 50% of the cases yielded a quantitatively balanced knee. Significantly more balanced knees were observed in the sensor-guided group (84.0%). More importantly, for both outcome measures, the balanced group of patients reported significantly better outcomes scores. CONCLUSION: This demonstrates that using sensor feedback during knee arthroplasty surgery results in a more reproducible procedure, resulting in a higher percentage of balanced patients who in turn demonstrate superior clinical outcomes compared to unbalanced patients.

Differential Inhibitory Receptor Expression on T Cells Delineates Functional Capacities in Chronic Viral Infection.

Inhibitory receptors have been extensively described for their importance in regulating immune responses in chronic infections and cancers. Blocking the function of inhibitory receptors such as PD-1, CTLA-4, 2B4, Tim-3, and LAG-3 has shown promise for augmenting CD8 T cell activity and boosting pathogen-specific immunity. However, the prevalence of inhibitory receptors on CD4 T cells and their relative influence on CD4 T cell functionality in chronic HIV infection remains poorly described. We therefore determined and compared inhibitory receptor expression patterns of 2B4, CTLA-4, LAG-3, PD-1, and Tim-3 on virus-specific CD4 and CD8 T cells in relation to their functional T cell profile. In chronic HIV infection, inhibitory receptor distribution differed markedly between cytokine-producing T cell subsets with, gamma interferon (IFN-γ)- and tumor necrosis factor alpha (TNF-α)-producing cells displaying the highest and lowest prevalence of inhibitory receptors, respectively. Blockade of inhibitory receptors differentially affected cytokine production by cells in response to staphylococcal enterotoxin B stimulation. CTLA-4 blockade increased IFN-γ and CD40L production, while PD-1 blockade strongly augmented IFN-γ, interleukin-2 (IL-2), and TNF-α production. In a Friend retrovirus infection model, CTLA-4 blockade in particular was able to improve control of viral replication. Together, these results show that inhibitory receptor distribution on HIV-specific CD4 T cells varies markedly with respect to the functional subset of CD4 T cells being analyzed. Furthermore, the differential effects of receptor blockade suggest novel methods of immune response modulation, which could be important in the context of HIV vaccination or therapeutic strategies.IMPORTANCE Inhibitory receptors are important for limiting damage by the immune system during acute infections. In chronic infections, however, their expression limits immune system responsiveness. Studies have shown that blocking inhibitory receptors augments CD8 T cell functionality in HIV infection, but their influence on CD4 T cells remains unclear. We assessed the expression of inhibitory receptors on HIV-specific CD4 T cells and their relationship with T cell functionality. We uncovered differences in inhibitory receptor expression depending on the CD4 T cell function. We also found differences in functionality of CD4 T cells following blocking of different inhibitory receptors, and we confirmed our results in a Friend virus retroviral model of infection in mice. Our results show that inhibitory receptor expression on CD4 T cells is linked to CD4 T cell functionality and could be sculpted by blockade of specific inhibitory receptors. These data reveal exciting possibilities for the development of novel treatments and immunotherapeutics.

Alarmingly High Rate of Implant Fractures in One Modular Femoral Stem Design: A Comparison of Two Implants.

BACKGROUND: Reports of implant fracture at the modular junction have been seen in modular neck designs, stem-sleeve modular femoral stems, and diaphyseal engaging bi-body modular stems. To date, however, there has never been a direct comparison between 2 different implant designs from the same modular family. The purpose of this study is to compare the rate of implant failure of 2 such stem-sleeve modular femoral stem designs, the S-ROM and Emperion, to further identify factors which increase the risk of this mode of failure. METHODS: A retrospective, single surgeon, review of our institutional database was performed to compare the 2 groups of patients. RESULTS: A total of 1168 total hip arthroplasty procedures were included in our analysis, 547 (47%) with Emperion and 621 (53%) with S-ROM. Eight (1.5%) fractures in 7 patients occurred in the Emperion group compared to 1 (0.2%) fracture in the S-ROM group (P = .015). CONCLUSION: The precise cause of the stem fractures in our study remains unknown and is likely multifactorial. Given the unexpectedly high rate of catastrophic implant failures in the form of stem fracture at the stem-sleeve junction, we recommend more judicious use of modularity in primary total hip arthroplasty.

Correlation between Chiral Modifier Adsorption and Enantioselectivity in Hydrogenation Catalysis.

Infrared absorption spectroscopy performed in situ at the solid-liquid interface revealed that the adsorption on platinum supported catalysts of 1-(1-naphthyl)-ethylamine, which is used as a chiral modifier in hydrogenation catalysis, occurs through the amine group, not the aromatic ring as is widely believed. Comparisons were performed against a set of related modifier compounds with targeted substitutions to help identify the key moiety involved in the adsorption. It was determined that neither naphthalene-based modifiers without amine groups nor those with tertiary amine moieties are capable of adsorbing on the metal surface to any significant extent. A direct correlation was also found between the ability of the amines to adsorb on the platinum surface and their performance as chiral modifiers that impart enantioselectivity to the hydrogenation of α-keto esters such as ethyl pyruvate.

Transitioning to the Direct Anterior Approach in Total Hip Arthroplasty: Is It Safe in the Current Health Care Climate?

BACKGROUND: The direct anterior approach for total hip arthroplasty has recently gained interest for its quicker short-term recovery despite concerns about increased complications and operative time, especially during the steep learning curve period. The primary goal of this study was to determine if the transition from a posterior approach to a direct anterior approach for total hip arthroplasty can be achieved without harming patient safety. METHODS: This is a retrospective cohort single-surgeon study of consecutive primary total hip arthroplasties performed over a transition period from posterior to direct anterior (DA) approach. RESULTS: A total of 412 patients (211 anterior, 201 posterior) were included with no significant demographic differences between cohorts. There were no significant differences between the DA and posterior group in 30-day readmission rates (2.84% vs 2.49%, P = .823), 90-day readmission rates (4.27 vs 5.97, P = .432), complication rate (6.16% vs 3.48%, P = .206), or revision rate (1.90% vs 2.99%, P = .535). The DA group had a significantly lower percentage of cases outside the goal abduction angle range (35°-50°) than the posterior group (9.52%, n = 20 vs 19.6%, n = 39, P < .01). The number of cases outside the goal leg length discrepancy range (±10 mm) was not significantly different (P = .846) between the DA (12.9%) and posterior (13.6%) groups. CONCLUSION: This single-surgeon study demonstrates that the DA approach can be transitioned to safely with no significant increase in complications or readmissions over a high-volume experienced surgeon's first 200 cases. Furthermore, our results endorse the consistency of the DA approach during the learning curve period in regard to component positioning compared to posterior approach.

Switching anti-CGRP monoclonal antibodies in chronic migraine: real-world observations of erenumab, fremanezumab and galcanezumab.

OBJECTIVES: The anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAb) are effective in migraine; however, few studies have examined the benefit of switching from one anti-CGRP-mAb to another. In order to better inform clinical practice in this situation, we present our real-world findings of switching anti-CGRP-mAb in chronic migraine. METHODS: Individuals with chronic migraine that switched anti-CGRP-mAb treatment (erenumab, fremanezumab or galcanezumab) due to ineffectiveness or adverse effects were retrospectively identified. Headache diary data before and up to 6 months after anti-CGRP-mAb switch were analysed. Main outcome measures were monthly red days (days with headaches limiting activity or requiring triptans), headache days (days with any kind of headache), triptan use, other analgesic use and headache disability (Headache Impact Test-6 (HIT-6) score) at 3 months. RESULTS: The analysis included 66 instances of switching among 54 individuals. There were non-significant reductions of -1.2 (-2.7, 0.3) red days from baseline at 3 months, with 10 individuals (15%) showing ≥50% improvement and 22 (33%) experiencing a ≥30% improvement. Improvements in headache days, triptan days, other painkiller use and HIT-6 score were non-significant. When individuals that switched due to side effects were excluded from the analysis, significant reductions in headache (Friedman p=0.044) and a trend for improvement in red days (Friedman p=0.083) were observed. With regard to side effects, on 12 occasions these improved or resolved on switching to a different anti-CGRP-mAb, while new symptoms were reported on eight occasions following a switch. CONCLUSION: We recorded modest improvements in headache outcomes, although significant results were only observed in those that switched anti-CGRP-mAb due to ineffectiveness. Switching may therefore be a viable option for these individuals.

Aquatic biofouling prevention by electrically charged nanocomposite polymer thin film membranes.

Electrically conductive polymer-nanocomposite (ECPNC) tight nanofiltration (NF) thin film membranes were demonstrated to have biofilm-preventing capabilities under extreme bacteria and organic material loadings. A simple route to the creation and application of these polyamide-carbon nanotube thin films is also reported. These thin films were characterized with SEM and TEM as well as FTIR to demonstrate that the carbon nanotubes are embedded within the polyamide and form ester bonds with trimesoyl chloride, one of the monomers of polyamide. These polymer nanocomposite thin film materials boast high electrical conductivity (∼400 S/m), good NaCl rejection (>95%), and high water permeability. To demonstrate these membranes' biofouling capabilities, we designed a cross-flow water filtration vessel with insulated electrical leads connecting the ECPNC membranes to an arbitrary waveform generator. In all experiments, conducted in highly bacterially contaminated LB media, flux tests were run until fluxes decreased by 45 ± 3% over initial flux. Biofilm-induced, nonreversible flux decline was observed in all control experiments and a cross-flow rinse with the feed solution failed to induce flux recovery. In contrast, flux decrease for the ECPNC membranes with an electric potential applied to their surface was only caused by deposition of bacteria rather than bacterial attachment, and flux was fully recoverable following a short rinse with the feed solution and no added cleaning agents. The prevention of biofilm formation on the ECPNC membranes was a long-term effect, did not decrease with use, and was highly reproducible.

Reduction of nitrite and nitrate on nano-dimensioned FeS.

The reaction of nitrite (NO2(-)) and nitrate (NO3(-)) on nanometer-sized FeS particles was investigated in alkaline (initial pH = 10.3) solutions at reaction temperatures of 22, 70, and 120 °C using in situ attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and fluorescence spectroscopy that allowed an analysis of adsorbate complexation on the FeS and reaction product in the aqueous phase, respectively. ATR-FTIR showed that NO was a surface-bound intermediate on FeS during its exposure to NO2(-) at all three reaction temperatures. Ammonia/ammonium (NH3/NH4(+)) product was also produced when FeS was exposed to NO2(-) at the 70 °C and 120 °C reaction temperatures. Activation of NO3(-) to form surface-bound NO was experimentally observed to occur at 120 °C on FeS, but not at the lower reaction temperatures. Furthermore, NH3/NH4(+) product in the aqueous phase was only present during the reaction of FeS with NO3(-) at the highest temperature used in this study.

Reduction of nitrite and nitrate to ammonium on pyrite.

An important constraint on the formation of the building blocks of life in the Hadean is the availability of small, activated compounds such as ammonia (NH(3)) relative to its inert dinitrogen source. Iron-sulfur particles and/or mineral surfaces have been implicated to provide the catalytic active sites for the reduction of dinitrogen. Here we provide a combined kinetic, spectroscopic, and computational modeling study for an alternative source of ammonia from water soluble nitrogen oxide ions. The adsorption of aqueous nitrite (NO(2)(-)) and nitrate (NO(3)(-)) on pyrite (FeS(2)) and subsequent reduction chemistry to ammonia was investigated at 22°C, 70°C, and 120°C. Batch geochemical and in situ Attenuated Total Reflection - Fourier Transform Infrared (ATR-FTIR) spectroscopy experiments were used to determine the reduction kinetics to NH(3) and to elucidate the identity of the surface complexes, respectively, during the reaction chemistry of NO(2)(-) and NO(3)(-). Density functional theory (DFT) calculations aided the interpretation of the vibrational data for a representative set of surface species. Under the experimental conditions used in this study, we detected the adsorption of nitric oxide (NO) intermediate on the pyrite surface. NH(3) production from NO(2)(-) occurred at 70 and 120°C and from NO(3)(-) occurred only at 120°C.

Rotating platform revision total knee arthroplasty.

Although revision total knee arthroplasty (TKA) procedures are successful in relieving pain and restoring function in failed knees, long-term results are inferior to primary procedures. Mobile bearing (MB) revision knees can potentially improve functional performance. Clinical results of 44 MB rotating platform (RP) revision TKAs demonstrated mean knee injury and osteoarthritis outcome score (KOOS) activity of daily living score of 77 2 years postoperatively. Clinical results were put into context through wear testing which demonstrated improved wear performance compared with fixed bearing (FB) revision knees. The RP construct is a good choice for revision TKA because it permits the surgeon to align the tray for fixation, not compromise rotation of the tibial insert, and reduce transmission of shear stresses to the bone, cement and implant interface, which is a known cause of failure.

Synthesis of tetranuclear, four-coordinate manganese clusters with "pinned butterfly" geometry formed by metal-mediated N-N bond cleavage in diphenylhydrazine.

The preparation of four-coordinate tetramanganese-amide-hydrazide clusters is described. Reaction of Mn(NR(2))(2) (R = SiMe(3)) with N,N'-diphenylhydrazine resulted in the formation of a black intermediary mixture that converted to a four-coordinate tetranuclear "pinned butterfly" cluster, Mn(4)(µ(3)-N(2)Ph(2))(2)(µ-N(2)Ph(2))(µ-NHPh)(2)(THF)(4). This compound was isolated in ~90% yield and identified by single-crystal X-ray diffraction analysis. In pyridine, the THF ligands were replaced, giving the pyridyl complex Mn(4)(µ(3)-N(2)Ph(2))(2)(µ-N(2)Ph(2))(µ-NHPh)(2)(py)(4). Charge counting considerations indicate that the clusters had gained two protons and two electrons in addition to the formative fragments. Isolation of the black mixture was achieved by extraction techniques from a reaction with a decreased loading of hydrazine run at low temperatures with decreased solvent polarity. The black mixture was characterized by FT-IR, UV-vis, and (1)H NMR spectroscopy. In addition, an isolable, colorless dimer, Mn(2)(µ-NHPh)(2)(NR(2))(2)(THF)(2), was present in the mixture and identified by single-crystal X-ray diffraction. These intermediates are discussed in light of possible mechanisms for formation of the tetranuclear cluster.

Intraoperative molds to create an articulating spacer for the infected knee arthroplasty.

BACKGROUND: Chronic infections in TKA have been traditionally treated with a two-stage protocol incorporating a temporary antibiotic-loaded cement spacer. The use of a static as opposed to an articulating spacer is controversial. Some surgeons believe a static spacer results in a higher rate of infection eradication, whereas others believe an articulating spacer provides equivalent rates of infection control with improved function between stages and the potential for better eventual range of motion. QUESTIONS/PURPOSES: We determined the rates of infection control and postoperative function for an articulating all-cement antibiotic spacer fashioned intraoperatively from prefabricated silicone molds. METHODS: We retrospectively reviewed 60 patients with an infected TKA using the same cement-on-cement articulating spacer. A minimum of 4 g antibiotic per package of cement was used when making the spacer. Complications and pre- and postoperative knee flexion, extension, and Knee Society scores were recorded. Bone loss associated with the spacer was determined radiographically and by intraoperative inspection of the bony surfaces at the second stage. Minimum followup was 24 months (mean, 35 months; range, 24-51 months). RESULTS: Seven patients (12%) became reinfected, four with an organism different from that identified at the index resection arthroplasty. One spacer femoral component broke between stages but did not require any specific treatment. We identified no bone loss between stages and no complications related to the cement-on-cement articulation. The mean pretreatment Knee Society scores of 53 improved to 79. The mean preoperative flexion of 90.6º improved to 101.3º at final followup. CONCLUSIONS: An articulating antibiotic spacer was associated with control of a deep periprosthetic infection in 88% of patients while allowing range of motion between stages. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

A Workflow Change in Anterior Approach Total Hip Arthroplasty Leads to Improved Accuracy of Biomechanical Reconstruction Without Increased Risk of Complications.

BACKGROUND: During anterior approach total hip arthroplasty (THA), the femur may be an impediment for acetabular access, pushing reamers proximally and consequently altering the hip center. In an effort to address this, the senior author changed the surgical workflow from acetabulum first (AF) to femur first (FF). The objective of this study was to compare the precision of biomechanical hip reconstruction and clinical outcomes between the FF and AF techniques. METHODS: This is a retrospective, case-control study of 267 anterior THAs (132 AF and 135 FF). A normal, contralateral hip was used to determine the native biomechanical parameters. Using a calibrated software program, radiographic measurements were performed to calculate the hip center position, femoral offset, global offset, and leg length of the operative and native hips using 2-week postoperative anteroposterior pelvis radiographs. Demographics, operative information, hemoglobin change, and complication data were obtained. Functional outcomes were assessed with the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement survey at 1 year postoperatively. RESULTS: The groups exhibited similar demographic characteristics. The FF group demonstrated significantly more accurate and more precise reconstruction of horizontal and vertical hip centers, femoral offset, and leg length. There was no significant difference in operative time, hemoglobin change, complication rate, or Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores between groups. CONCLUSIONS: The FF technique allowed for more accurate and precise reconstruction of the hip center, leg length, and offset in THA than the AF workflow. Furthermore, the FF approach demonstrated no significant differences in complication rate or blood loss, nor in clinical outcomes. LEVEL OF EVIDENCE: Therapeutic Study Level III.

The Actis and Corail Femoral Stems Provide for Similar Clinical and Radiographic Outcomes in Total Hip Arthroplasty.

BACKGROUND: The introduction of new devices for total hip arthroplasty (THA) offers surgeons the ability to address deficits in the portfolio. However, once introduced, data regarding the performance of devices is not publicly available until their use is widespread. PURPOSE/QUESTIONS: The objective of this study was to compare the clinical and radiographic performance, including patient reported outcomes and radiographic evidence of osseointegration, subsidence, and stress shielding, of the newer Actis femoral component to the Corail stem (DePuy Synthes, Warsaw, IN, USA), which has an extensive clinical history. METHODS: This short-term, retrospective cohort study was a single surgeon series of 330 anterior approach THAs, consisting of 165 cases using the Actis stem and 165 cases using the Corail stem. Both devices were cementless, titanium, tapered, hydroxyapatite-coated stems. They differed in geometry, neck choices, broach philosophy, and collar availability. Data was obtained for 1 year following THA. Functional outcomes were measured with the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.) survey. Complications were recorded from patient charts, and radiographic analysis was performed for signs of osseointegration, subsidence, and stress shielding. RESULTS: The groups shared similar demographic characteristics except the Actis population was younger with fewer women. The complication rate did not significantly vary, and no patient required revision within the first year. Radiographically, one patient in each group demonstrated subsidence. No cases exhibited radiolucent lines, and the prevalence of stress shielding at 1 year was comparable. HOOS, JR. scores did not significantly vary at 8 weeks or 1 year. CONCLUSION: The Actis stem does not carry an increased risk of device-related complications compared with the Corail implant. Although aspects of bone remodeling differed between groups, Actis achieved radiographic signs of bone ingrowth at the 1-year mark and performed well clinically, with equivalent patient reported outcome scores to the Corail stem.