Polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus is associated with a high complication rate and moderate failure rate at short-term follow-up: a systematic review.

PURPOSE: Moderate-to-severe hallux rigidus is a debilitating pathology that is optimally treated with surgical intervention. Arthrodesis produces reliable clinical outcomes but is limited by restriction in 1st metatarsophalangeal joint range of motion. The advent of polyvinyl alcohol hydrogel (PVA) implants have produced early promise based on initial trials, but more recent studies have called into question the efficacy of this procedure. The purpose of this systematic review was to evaluate the clinical and radiological outcomes following the use of PVA for hallux rigidus. METHODS: The MEDLINE, EMBASE and Cochrane library databases were systematically reviewed using the preferred reporting items for systematic reviews and meta-analyses guidelines. 18 studies were included. RESULTS: In total, 1349 patients (1367 feet) underwent PVA at a weighted mean follow-up of 24.1 ± 11.1 months. There were 168 patients (169 feet) included in the cheilectomy cohort and 322 patients (322 feet) included in the arthrodesis cohort. All 3 cohorts produced comparable improvements in subjective clinical outcomes. Postoperative imaging findings in the PVA cohort included joint space narrowing, peri-implant fluid, peri-implant edema and erosion of the proximal phalanx. The complication rate in the PVA cohort, cheilectomy cohort and arthrodesis cohort was 27.9%, 11.8% and 24.1%, respectively. The failure rates in the PVA cohort, cheilectomy cohort and arthrodesis cohort was 14.8%, 0.3% and 9.0%, respectively. CONCLUSION: This systematic review demonstrated that PVA produced a high complication rate (27.9%) together with concerning postoperative imaging findings at short-term follow-up. In addition, a moderate failure rate (14.8%) and secondary surgical procedure rate (9.5%) was noted for the PVA cohort. The findings of this review calls into question the efficacy and safety of PVA for the treatment of hallux rigidus. LEVEL OF EVIDENCE: IV.

Patient-Reported Outcomes and Survivorship Are Not Different for Primary Hip Arthroscopy Patients of Age 50 Years and Older Compared With a 20- to 35-Year-Old Matched Cohort at Minimum 5-Year Follow-Up.

PURPOSE: To assess clinical outcomes among patients aged 50 years or older after primary hip arthroscopy for femoroacetabular impingement (FAI) with or without labral tears compared with a matched control group of younger patients aged 20 to 35 years old at minimum 5-year follow-up. METHODS: We conducted a retrospective comparative prognostic study using a prospectively collected database of patients who underwent hip arthroscopy with minimum 5-year follow-up. Subjects completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) before surgery and at 5-year follow-up. Patients aged ≥50 years were propensity score matched on sex, body mass index, and preoperative mHHS to controls aged 20 to 35 years. Pre- to postoperative changes in mHHS and NAHS were compared between groups using the Mann-Whitney U test. Hip survivorship rates and minimum clinically important difference achievement rates were compared between groups using the Fisher exact test. P values <.05 were considered statistically significant. RESULTS: In total, 35 older patients (mean age 58.3 years) were matched to 35 younger controls (mean age 29.2 years). Both groups were mostly female (65.7%) and had equal mean body mass index (26.0). Acetabular chondral lesions of Outerbridge grades III-IV were more prevalent in the older group (older 28.6% vs younger 0%, P < .001). Five-year reoperation rates were not significantly different between the groups (older 8.6% vs younger 2.9%, P = .61). There were no significant intergroup differences in 5-year improvement in mHHS (older 32.7 vs younger 30.6, P = .46) or NAHS (older 34.4 vs younger 37.9, P = .70) or in 5-year minimum clinically important difference achievement rates for the mHHS (older 93.6% vs younger 93.6%, P = 1.00) or NAHS (older 87.1% vs younger 96.8%, P = .35). CONCLUSIONS: There are no significant differences in reoperation rates and patient-reported outcomes between patients aged ≥50 years versus matched controls aged 20 to 35 years after primary hip arthroscopy for FAI. LEVEL OF EVIDENCE: Level III, retrospective comparative prognostic study.

HIV-1 Proteins Influence Novelty-Seeking Behavior and Alter Region-Specific Transcriptional Responses to Chronic Nicotine Treatment in HIV-1Tg Rats.

INTRODUCTION: Clinical studies suggest that HIV-1-infected patients are more likely to use or abuse addictive drugs than is the general population. We hypothesized that HIV-1 proteins impact novelty-seeking behavior and enhance the transcriptional response to nicotine in genes implicated in both novelty-seeking behavior and drug addiction. METHODS: We assessed the effects of HIV-1 proteins on novelty-seeking behavior by comparing baseline activity differences of HIV-1Tg and F344 control rats in the open-field test. One day after behavioral testing, all rats began daily subcutaneous injections of either nicotine (0.4 mg/kg, base) or saline (the same for each rat) for 27 days. At the end of treatment, the prefrontal cortex, nucleus accumbens, and ventral tegmental area were collected for RNA expression analysis of genes in the receptor families for dopamine, GABA, glutamate, and serotonin. RESULTS: Significant strain difference was detected in the distance moved in the center, such that HIV-1Tg rats traveled greater distance in the center of the arena than did F344 rats. Quantitative RT-PCR analysis showed that mRNA from Drd3 and Grm2 in the prefrontal cortex and Drd5 and Gabra6 in the ventral tegmental area was significantly upregulated, whereas that of Drd5 in the nucleus accumbens was downregulated in HIV-1Tg rats compared with F344 rats. Further, more addiction-related genes were significantly modulated by nicotine in each brain region in the HIV-1Tg rats than in the control animals. CONCLUSIONS: HIV-1 proteins may affect novelty-seeking behavior and modulate the expression of genes related to drug addiction and novelty-seeking behavior. IMPLICATIONS: HIV-1 viral proteins and chronic nicotine treatment impact the expression of genes involved in novelty-seeking behavior and addiction in three brain regions of the HIV-1 transgenic rat. These findings implicate that HIV-1 proteins may be involved in novelty-seeking behavior and in modulating the expression of genes related to drug addiction and novelty seeking.

Interactive Effects of Ethanol and HIV-1 Proteins on Novelty-Seeking Behaviors and Addiction-Related Gene Expression.

BACKGROUND: Novelty-seeking behavior is related to the reward system in the brain and can predict the potential for addiction. Alcohol use is prevalent in HIV-1-infected patients and adversely affects antiretroviral medication. The difference in vulnerability to alcohol addiction between HIV-1-infected and noninfected populations has not been fully investigated. This study was designed to determine whether HIV-1 proteins alter the effects of ethanol (EtOH) on novelty-seeking behavior using the HIV-1 transgenic (HIV-1Tg) rat as the study model and to examine the molecular mechanisms responsible for this behavior. METHODS: Both HIV-1Tg and F344 control rats were tested for baseline novelty-seeking behavior, then received either EtOH (1 g/kg) at a concentration of 20% v/v or saline treatment for 13 days, and then were retested for novelty seeking. Quantitative real-time polymerase chain reaction was conducted to examine the differences in expression of 65 genes implicated in novelty seeking and alcohol addiction between strains and treatment groups. RESULTS: The HIV-1 proteins significantly enhanced baseline novelty-seeking behaviors in both the hole-board and open-field tests. Chronic EtOH treatment significantly increased baseline novelty-seeking behavior in both strains, but the effects of EtOH appeared to be more robust and prominent in HIV-1Tg rats. Strain-specific patterns of altered gene expression were observed for dopaminergic, cholinergic, and glutamatergic signaling in the nucleus accumbens, suggesting the effects of HIV-1 proteins on the brain's reward system. Chronic EtOH treatment was shown to greatly modulate the effects of HIV-1 proteins in these neurotransmitter systems. CONCLUSIONS: Taken together, our findings indicate that HIV-1 proteins could modify novelty-seeking behavior at the gene expression level, and EtOH treatment may enhance this behavior in both strains but to a greater extent in HIV-1Tg rats.

Presurgical and Postsurgical MRI Evaluation of Osteochondral Lesions of the Foot and Ankle: A Primer.

The gold standard diagnostic imaging tool for ankle OCLs is magnetic resonance imaging, which allows precise evaluation of the articular cartilage and assessment of the surrounding soft tissue structures. Post-operative morphologic MRI assessment via MOCART scores provide semi-quantitative analysis of the repair tissue, but mixed evidence exists regarding its association with post-operative outcomes. Post-operative biochemical MRIs allow assessment of the collagen network of the articular cartilage via T2-mapping and T2∗ mapping, and assessment of the articular glycosaminoglycan content via delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho mapping and sodium imaging.

Temporal trends in surgical implants for in situ fixation of stable slipped capital femoral epiphysis.

Stable slipped capital femoral epiphysis (SCFE) is a pediatric hip disorder managed with in situ fixation of the proximal femoral epiphysis, otherwise known as 'pinning the hip'. The objective of this study was to characterize how the choice of implant for in situ fixation of stable SCFE has changed over time. A systematic review of publications concerning in situ fixation of stable SCFE from January 1993 to November 2021 was conducted. The change in the type, diameter, and number of implants used in publications over time and the age of their respective patient cohorts was evaluated. A total of 207 articles met inclusion criteria. There was an increase in publications using cannulated screws over time (P = 0.0113). As the yearly percentage of publications using threadless non-cannulated implants decreased (P = 0.0309), the percentage using cannulated screws increased (P = 0.0047). Single-implant fixation also increased (P = 0.0409). While there was no difference in the rate of increase of implants < 7 mm or ≥ 7 mm in diameter (P = 0.299), patients with larger-diameter implants were, on average, older than patients with smaller-diameter implants (P = 0.0462). In general, the age of patients undergoing in situ fixation of stable SCFE has not changed (P = 0.595). Irrespective of patient-specific considerations, single cannulated screws have become the implant of choice for in situ fixation of stable SCFE. There has not been a consensus on the optimal implant diameter; instead, patient-specific considerations are of paramount importance in this decision.

Endoscopic Excision of Hip Heterotopic Ossification, Plus Indomethacin and Radiation, Is Effective in Treating and Preventing Recurrence.

Purpose: To describe the clinical and patient-reported outcomes of heterotopic ossification (HO) excision as well as the results of a standardized HO prophylaxis protocol among a group of patients who previously underwent open or arthroscopic hip surgery. Methods: Patients who developed HO after index hip surgery and were subsequently treated with arthroscopic excision of HO and postoperative HO prophylaxis using 2 weeks of indomethacin and radiation were retrospectively identified. All patients were seen by a single surgeon and were treated with the same arthroscopic technique. Patients were also placed on a regimen of 2 weeks of indomethacin 50 mg and radiation therapy with 700 cGy in one fraction on the first postoperative day. Outcomes assessed included recurrence of HO and conversion to total hip arthroplasty by latest follow-up. Other outcomes included Modified Harris Hip Scores and Non-Arthritic Hip Scores, which were collected preoperatively and at 1-year and 2-year follow-up. Results: There were 5 female and 9 male subjects, with an average age of 39 years (range 22-66) and average body mass index of 27.1 (19.1-37.5). Average follow-up time was 46 months (range 4-136). No patients had experienced HO recurrence by latest follow-up. Only 2 patients converted to total hip arthroplasty, one at 6 months and the other at 11 months postexcision. Average outcome scores improved by 2-year follow-up (average Modified Harris Hip Scores 52.8 improved to 86.5, average Non-Arthritic Hip Scores 49.4 improved to 83.8). Conclusions: Minimally invasive arthroscopic excision of HO and postoperative prophylaxis with combined indomethacin and radiation therapy effectively treats and prevents the recurrence of HO. Level of Evidence: Level IV, case series, therapeutic.

Assessment of Healthcare Delivery Systems in Orthopaedic Surgery: A Large Retrospective Cohort Evaluation.

INTRODUCTION: The purpose of this study was to assess how quality and volume of common orthopaedic care varies across private, municipal, and federal healthcare delivery systems (HDSs). METHODS: Hip and knee arthroplasty, knee and shoulder arthroscopy, and hip fracture repair were audited over a two-year period. Electronic medical records were reviewed for demographics, diagnosis, lengths of stay (LoSs), surgical wait times, inpatient complication, readmission, and revision surgery rates. Multivariate regression controlled for differences in age, sex, diagnosis, and Charlson Comorbidity Index to determine how HDS correlated with surgical wait time, length of stay, complication rates, readmission, and revision surgery. RESULTS: The 5,696 included patients comprise 87.4% private, 8.6% municipal, and 4.0% federal HDSs. Compared with private HDS for arthroplasty, federal surgical wait times were 18 days shorter (95% CI = 9 to 26 days, P < 0.001); federal LoS was 4 days longer (95% CI = 3.6 to 4.3 days, P < 0.001); municipal LoS was 1 day longer (95% CI = 0.8 to 1.4, P < 0.001); municipal 1-year revision surgery odds were increased (odds ratio [OR] = 2.8, 95% CI = 1.3 to 5.4, P = 0.045); and complication odds increased for municipal (OR = 12.2, 95% CI = 5.2 to 27.4, P < 0.001) and federal (OR = 12.0, 95% CI = 4.5 to 30.8, P < 0.001) HDSs. Compared with private HDS for arthroscopy, municipal wait times were 57 days longer (95% CI = 48 to 66 days, P < 0.001) and federal wait times were 34 days longer (95% CI = 21 to 47 days, P < 0.001). Compared with private HDS for fracture repair, municipal wait times were 0.6 days longer (95% CI = 0.2 to 1.0, P = 0.02); federal LoS was 7 days longer (95% CI = 3.6 to 9.4 days, P < 0.001); and municipal LoS was 4 days longer (95% CI = 2.4 to 4.8, P < 0.001). Only private HDS fracture repair patients received bone health consultations. DISCUSSION: The private HDS provided care for a markedly larger volume of patients seeking orthopaedic care. In addition, private HDS patients experienced reduced surgical wait times, LoSs, and complication odds for inpatient elective cases, with better referral patterns for nonsurgical orthopaedic care after hip fractures within the private HDS. These results may guide improvements for federal and municipal HDSs.

Novelty Seeking and Drug Addiction in Humans and Animals: From Behavior to Molecules.

Global treatment of drug addiction costs society billions of dollars annually, but current psychopharmacological therapies have not been successful at desired rates. The increasing number of individuals suffering from substance abuse has turned attention to what makes some people more vulnerable to drug addiction than others. One personality trait that stands out as a contributing factor is novelty seeking. Novelty seeking, affected by both genetic and environmental factors, is defined as the tendency to desire novel stimuli and environments. It can be measured in humans through questionnaires and in rodents using behavioral tasks. On the behavioral level, both human and rodent studies demonstrate that high novelty seeking can predict the initiation of drug use and a transition to compulsive drug use and create a propensity to relapse. These predictions are valid for several drugs of abuse, such as alcohol, nicotine, cocaine, amphetamine, and opiates. On the molecular level, both novelty seeking and addiction are modulated by the central reward system in the brain. Dopamine is the primary neurotransmitter involved in the overlapping neural substrates of both parameters. In sum, the novelty-seeking trait can be valuable for predicting individual vulnerability to drug addiction and for generating successful treatment for patients with substance abuse disorders.