Backside polyethylene wear in reverse shoulder arthroplasty.

BACKGROUND: Aseptic loosening from implant-associated osteolysis in reverse shoulder arthroplasty (RSA) may contribute to premature implant failure. Although articular side polyethylene (PE) damage has been well documented in the literature, no studies to date have investigated backside wear in RSA. The aims of this investigation were to (1) document and compare the damage between the backside and articular surface in explanted RSA components, (2) assess whether certain quadrants have a greater propensity for damage, and (3) report the most common mode(s) of backside PE damage. METHODS: Twenty-one RSA humeral liners retrieved during revision procedures between 2005 and 2014 were included for analysis. The mean time between implantation and extraction was 16 months (10 days-88 months). Diagnoses at the time of revision included dislocation (10), infection (4), mechanical failure (3), loosening (2), and unknown (2). Liners were examined under light microscopy (×10-30 magnification) and damage on the articular and backside of the liner surface was graded using the modified Hood score. The location and damage modality were compared between the articular side and backside of the implant. RESULTS: Damage was noted on the articular surfaces of all 21 liners and on the backside surface of 20 liners. The total damage in all the quadrants was higher on the articular surface than on the backside of the component, with a mean difference in total quadrant damage scores of 11.74 ± 3.53 (P < .001). There was no difference in damage among the quadrants on the backside (P = .44) or the articular surface (P = .08). The articular side exhibited greater scratching, abrasion, and surface deformation than the backside (P < .001). CONCLUSIONS: This short-term retrieval study demonstrated that backside PE damage occurs on the humeral component of RSA implants. There was greater damage to the articular side of the liner but wear to the backside was present in almost all liners. The clinical importance of backside wear in RSA and its overall contribution to PE particulate disease and osteolysis needs further investigation.

Integrating Social Media and Anterior Cruciate Ligament Surgery: An Analysis of Patient, Surgeon, and Hospital Use.

PURPOSE: The purpose of this observational study of social media in sports medicine was to investigate and analyze the presence and shared content of anterior cruciate ligament (ACL) patients, sports surgeons, and top orthopaedic hospitals on popular social media streams. METHODS: A search of 2 public domains (Instagram and Twitter) was performed over a 6-month period. ACL surgery ("#aclsurgery") was selected for the Instagram-based patient analysis after exclusion of veterinary ACL operations. A binary scoring system was used for media format, time (preoperatively or postoperatively), perioperative period (within 1 week of surgery), tone (positive or negative), return-to-work reference, return-to-play reference, rehabilitation reference, surgical-site reference, satisfaction reference, and dissatisfaction reference; perspective of the media was noted as well. A sample of 97 National Football League team surgeons was used for analysis of physician use in social media outlets and quantified by the number of posts. Hospital analysis categorized a sample of the top 50 orthopaedic hospitals by average number of posts and monthly posting rates with regard to orthopaedics, research, education, and personnel focus. RESULTS: In the patient analysis, 3,145 public posts of human subjects were shared on Instagram. Of these, 92% were personal recovery stories, with an emphasis on postoperative photographs (93%) with a positive tone (88%) more than 1 week after surgery (73%). Posts focused on surgical site (25%), return to play (30%), and postoperative rehabilitation (37%). Of the physicians, 16% had Twitter accounts, with an average of 94 posts per surgeon; none had Instagram accounts. Of the hospitals, 96% had Twitter accounts and 32% had Instagram accounts. Most of the hospital-based Instagram content in the sample was centered on patients or celebrities. CONCLUSIONS: Orthopaedic surgery has a large social media presence. Patients emphasize wound appearance, the rehabilitation process, and return to play. Ninety-six percent of hospitals are represented in social media outlets, whereas physicians are relatively under-represented. CLINICAL RELEVANCE: Social media offers a unique window into what truly matters to patients after surgery and may help us better manage expectations, enhance health care delivery, and improve marketing strategies.

Bony Patchwork: Mosaic Patterns of Evolution in the Skull of Electric Fishes (Apteronotidae: Gymnotiformes).

Mosaic evolution refers to the pattern whereby different organismal traits exhibit differential rates of evolution typically due to reduced levels of trait covariation through deep time (i.e., modularity). These differences in rates can be attributed to variation in responses to selective pressures between individual traits. Differential responses to selective pressures also have the potential to facilitate functional specialization, allowing certain traits to track environmental stimuli more closely than others. The teleost skull is a multifunctional structure comprising a complex network of bones and thus an excellent system for which to study mosaic evolution. Here we construct an ultrametric phylogeny for a clade of Neotropical electric fishes (Apteronotidae: Gymnotiformes) and use three-dimensional geometric morphometrics to investigate patterns of mosaic evolution in the skull and jaws. We find strong support for a developmental, three-module hypothesis that consists of the face, braincase, and mandible, and we find that the mandible has evolved four times faster than its neighboring modules. We hypothesize that the functional specialization of the mandible in this group of fishes has allowed it to outpace the face and braincase and evolve in a more decoupled manner. We also hypothesize that this pattern of mosaicism may be widespread across other clades of teleost fishes.

Evaluation of preemptive valdecoxib therapy on initial archwire placement discomfort in adults.

The purpose of this randomized, double-blinded, placebo-controlled prospective clinical trial was to compare the efficacy of preemptive and postoperative administration of valdecoxib in reducing discomfort caused by initial archwire placement in adults. A total of 56 orthodontic patients aged 18-54 years who were to begin treatment were randomly assigned to one of three groups: (1) placebo, (2) those who received preemptive valdecoxib 40 mg at least 30 minutes before initial archwire placement, or (3) those who received postoperative valdecoxib 40 mg two hours after initial archwire placement. Patients in the active treatment groups also received continuous valdecoxib therapy for an additional 48 hours. Discomfort levels were recorded on a visual analog scale at zero, two, six, 24, and 48 hours after initial archwire placement. At baseline, no significant differences were detected between the three groups. In the preemptive valdecoxib group, there was no significant increase (P > .05) in discomfort from baseline at any time point. The placebo and postoperative valdecoxib groups showed significant (P < .05) increases in discomfort after six hours, with the peak discomfort at 24 hours. The postoperative group showed a tendency toward decreased discomfort over time, but the changes were not significantly different from the placebo or the preemptive group. Preemptive analgesia with nonsteroidal anti-inflammatory drugs may be an approach to prevent discomfort associated with initial archwire placement in healthy adults.

A comparison of two meperidine/hydroxyzine sedation regimens for the uncooperative pediatric dental patient.

PURPOSE: The purpose of this study was to compare the safety and efficacy of submucosal-administered meperidine (SM) and oral-administered meperidine (OM). Both regimens were used in conjunction with oral hydroxyzine for the sedation of children for dental treatment. METHODS: Twenty preschool-age children, with previous histories of uncooperative behavior, were randomly assigned to first receive a sedation regimen of either SM (0.5 mg/ lb), or OM (1 mg/lb), both with oral hydroxyzine (0.5 mg/lb). A cross-over design was utilized so that each child received both regimens. Safety was monitored through vital signs and side effects. Efficacy was measured with Houpt and Frankl behavior ratings. RESULTS: Vital signs remained stable during both treatments. Differences noted were clinically insignificant. The major side effects reported during submucosal injection included pain (58%) and edema (26%). All blinded behavior ratings, in both sedation regimens, significantly improved from presedation Frankl ratings. No significant differences existed between treatments. Success was 63% in the SM group and 80% in the OM group. The percentages were not statistically significant (P=.219). CONCLUSIONS: Both methods of administration were found to be safe and effective for sedating uncooperative pediatric dental patients. Neither was significantly more effective or safer than the other.

Efficacy and economic evaluation of pilocarpine in treating radiation-induced xerostomia.

Xerostomia, resulting from therapeutic irradiation of the head and neck, can be debilitating and destructively impact the patient's quality of life. The first priority of treatment of radiation-induced xerostomia should be to preserve oral and dental health. Therapeutic doses of fluoride and meticulous dental hygiene are the treatments of choice for this purpose. Measures taken to prevent superinfection with cariogenic bacteria and fungi are also important. In addition to minimising damage to the dentition, it is important to provide palliative therapy to help the patient live a more normal life. Salivary substitutes help some patients but muscarinic, cholinergic sialogogues provide a more physiological replacement in those patients who have measurable residual salivary function. An oral formulation of pilocarpine hydrochloride is approved to treat radiation-induced xerostomia. In such cases, it has been shown to effectively stimulate salivary flow and relieve subjective symptoms associated with oral dryness. Administration of this drug is associated with predictable, but generally tolerable, adverse effects. Similar drugs, approved for other indications, have been shown to produce comparable results. These drugs are generally less expensive than the oral formulation of pilocarpine. As treatment of irradiation-induced xerostomia with muscarinic, cholinergic sialogogues is palliative, not curative, administration of these drugs should be individualised and guided by the patient's willingness to balance symptomatic efficacy with adverse effects and the expense of treatment.

The prevalence of periodontal-related changes in adolescents with asthma: results of the Third Annual National Health and Nutrition Examination Survey.

PURPOSE: The purpose of this study was to explore the association between asthma and periodontal disease in adolescents using oral examination and health interview data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994. METHODS: The study population comprised 1,596 adolescents 13 to 17 years of age: 253 (16%) asthmatics and 1,358 (84%) nonasthmatic controls who were examined for bleeding on probing (BOP), subgingival calculus (SBC), supragingival calculus (SPC), probing depth greater than or equal to 3 mm (PD), and loss of periodontal attachment greater than or equal to 2 mm (LPA). The authors fitted separate multivariate GEE Poisson regression models adjusting for parents' income, gender, race, exposure to potentially xerogenic drugs (antihistamines, corticosteroids, and inhalers), tobacco exposure, and dental examination within the past year. RESULTS: None of the periodontal measures was associated with asthma severity or with the use of antiasthmatic drugs. However, several covariates had statistically significant odds ratios (P < .05). CONCLUSIONS: There was no evidence to support the association between asthma and periodontal health in the adolescent population. Since the findings may be due to the inherent limitations of cross-sectional studies, the lack of knowledge about the daily dose of antiasthmatic medication, and the level of-compliance with the therapeutic regimen, future studies should be longitudinal and monitor medication use.