Reverse coronal deformity: use of robotic total knee arthroplasty for identification and correction.

BACKGROUND: Despite continued advances in techniques and implant designs, a population of patients who are dissatisfied after total knee arthroplasty (TKA) remains. During robotic-assisted arthroplasty, real-time intraoperative assessment of patient knee alignment is performed. Here, we assess the prevalence of an under-appreciated deformity, reverse coronal deformity (RCD), and the benefits of utilizing robotic-assisted knee arthroplasty to help correct this dynamic deformity. METHODS: A retrospective study evaluating patients undergoing robotic-assisted cruciate-retaining TKA was performed. Intraoperative measurements were obtained using tibial and femoral arrays to assess coronal plane deformity at full extension and at 90° flexion. RCD was defined as ≥ 2° varus in knee extension that reversed to ≥ 2° valgus in flexion, or vice-versa. Coronal plane deformity was then reassessed after robotic-assisted bony resection and implant placement. RESULTS: Of 204 patients that underwent TKA, 16 patients (7.8%) were found to have RCD, with 14 patients (87.5%) transitioning from varus in extension to valgus in flexion. The average coronal deformity was 7.75°, with a maximum of 12°. These improved to an average coronal change of 0.93° post-TKA. Final medial and lateral gaps were all balanced to within 1° in extension and flexion. Another 34 patients (16.7%) had ≥ 5° change in coronal plane deformity from extension to flexion (average 6.39°), however, did not experience a reversal of their coronal deformity. Outcomes were assessed with KOOS Jr. scores postoperatively. CONCLUSION: Computer and robotic assistance were utilized to demonstrate the prevalence of RCD. We also demonstrated accurate identification and successfully balancing of RCD utilizing robotic-assisted TKA. An increased awareness of these dynamic deformities could aid surgeons in proper gap balancing even in the absence of navigation and robotic-assisted surgery.

Circular external fixation for treatment of distal humerus fractures: case report.

High-energy blasts can lead to complex intra-articular distal humerus fractures with extensive soft tissue loss, and treatment is fraught with complications. We describe 2 patients with such injuries treated successfully with the use of aggressive wound management followed by distal humerus fracture stabilization with a circular external fixator. We chose this circular external fixator over the Ilizarov frame because of our experience and success in the treatment of open tibia fractures with negligible malalignment and high union rate. This circular external fixator allows for indirect reduction of fracture fragments over time to improve final alignment with great control to fine-tune the reduction postoperatively. In our humerus cases, fracture union was achieved with good alignment and acceptable functional range of motion. Symptomatic heterotopic ossification did not develop despite the presence of multiple risk factors.

Interaction of estrogen and progesterone on kisspeptin-10-stimulated luteinizing hormone and growth hormone in ovariectomized cows.

BACKGROUND/AIMS: Growth hormone (GH) is necessary for optimal reproductive efficiency and its secretion is influenced by sex steroids. This study was designed to determine whether kisspeptin-10 (Kp10) could stimulate GH and if gonadal steroids enhance the GH response to Kp10 in cows. METHODS AND RESULTS: Intravenous injection of Kp10 at 100 or 200 pmol/kg body weight with or without treatment with estradiol cypionate and/or progesterone increased luteinizing hormone (p < 0.01) plasma concentrations. Plasma concentrations of GH were increased following Kp10 in cows treated with estradiol cypionate and/or progesterone (p < 0.05) but not in cows treated with Kp10 without gonadal steroids. CONCLUSIONS: These data suggest that reproductive steroids enhance the sensitivity of the somatotropic axis to physiologically relevant doses of Kp10, and support the possibility that Kp10 is an integrator of luteinizing hormone and GH release.

A role for agouti-related protein in appetite regulation in a species with continuous nutrient delivery.

Knowledge of specific neurotransmitters as well as the pathways and mechanisms regulating appetite in ruminants that continually graze, such as sheep, is incomplete. Although fundamentally agouti-related protein (AGRP) has a similar function across species to increase food intake, the regulation of AGRP may vary across grazing and intermittent feeders. To investigate the role of orexigenic peptides in the regulation of feed intake, we first extracted messenger RNA from sheep that were fasted for 3 days, which was then used for PCR followed by cloning and sequencing to demonstrate the presence of hypothalamic AGRP expression. Ovine AGRP was closely related to the bovine, but contained sequence differences with human and mouse AGRP. Analysis of genomic DNA also revealed a similar gene structure to other published species. Secondly, using dual-labeled immunohistochemistry, we determined that there was both increased AGRP immunoreactivity and increased abundance of c-Fos immunoreactivity in AGRP neurons in the arcuate nucleus of fasted sheep. Because AGRP neurons are activated by fasting, we hypothesized that AGRP would stimulate feeding in this ruminant species. Sheep fed ad libitum were injected intracerebroventricularly with concentrations of AGRP at 0.2 and 2.0 nmol/kg. AGRP at 2.0 nmol/kg significantly increased food intake at 4, 6 and 12 h (p < 0.05). A 4th study was done to investigate the interactions of AGRP and neuropeptide Y (NPY) on food intake over a 24-hour period. Intracerebroventricular injections of either AGRP or NPY significantly increased cumulative food intake over saline controls. When AGRP and NPY were injected in combination, food intake was increased over saline controls; however, AGRP did not potentiate the effects of NPY. These results demonstrate that AGRP stimulates food intake in sheep and highlights the important differences between this species and rodent models.