Relation of tranexamic acid therapy to length of stay in the hip fracture population.

Tranexamic acid (TXA) is a medication that is routinely used to minimize blood loss during surgery. There is minimal literature evaluating the effects of TXA in hip fractures in regards to length of stay, readmission rates, and location of discharge. This study included adult patients who were admitted for hip fracture that required surgery over a 22-month period (May 2017-February 2019). A total of 525 hip fractures were operated on during this time period. Retrospective analysis was performed on patients treated with TXA (n = 27) vs those who were not (n = 498). Primary outcomes were length of stay, disposition after discharge, need for transfusion, mobilization with therapy, and readmission rates. TXA during hip fractures reduced median length of stay in the hip fracture cohort to 3 vs 5 days (P < 0.01). Patients were more likely to be discharged home as opposed to a nursing facility. Patients who received TXA during their hip fracture surgery were less likely to need transfusions while admitted (P < 0.01). No increased readmission rates were seen within 30 days after discharge (P = 0.59). In conclusion, when indicated, TXA appears to be safe for utilization in hip fracture surgery, resulting in decreased length of stay, less transfusions, and no increase in readmission rates.

Total Hip Arthroplasty in Patients With Severe Chronic Pubic Diastasis.

Background: Total hip arthroplasty (THA) in patients with severe chronic pubic diastasis from either congenital or acquired causes presents an exceptionally difficult challenge that has rarely been addressed in the arthroplasty literature. The purpose of this paper is to present a series of THAs in patients with severe chronic pubic diastasis, asking the following research questions: (1) What is the survivorship and clinical outcomes after THA in patients with severe chronic pubic diastasis? And (2) What is the rate of complications after THA surgery in this challenging patient population? We additionally describe our algorithm for preoperative planning and rationale for surgical technique and implant position. Material and methods: We retrospectively queried the prospective arthroplasty database of 2 high-volume referral centers, yielding 6 THA in 4 patients with severe chronic pubic diastasis (minimum 8 cm) with a mean follow-up of 2.7 years. We recorded baseline demographic and intraoperative variables, as well as survivorship, patient-reported outcomes (Hip disability and Osteoarthritis Outcome Score for Joint Replacement score), and incidence of complications. Results: There were no failures reported (100% survivorship) at a mean follow-up of 2.7 years. Mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement scores improved from 36.0 preoperatively to 82.8 postoperatively. There were no infections, dislocations, fractures, or any major complications in the postoperative period. Conclusion: THA for patients with severe chronic pubic diastasis remains a rare but challenging reconstructive procedure. Excellent outcomes can be achieved with adequate preparation, particularly regarding the acetabular component position. Understanding the nature of the hemipelvis deformity and meticulous templating using "normalized" views of the hip are important components to a successful preoperative plan.

Triaging Total Hip Arthroplasty During the COVID-19 Pandemic.

PURPOSE OF REVIEW: The purpose of this review was to evaluate the available literature to determine what may be considered urgent indications for total hip arthroplasty, in the unprecedented setting of the worldwide COVID-19 pandemic. RECENT FINDINGS: SARS-CoV-2 is a novel coronavirus currently presenting in the form of a global pandemic, referred to as COVID-19. In this setting, multiple states have issued executive orders prohibiting "elective" surgery, including arthroplasty, in order to preserve healthcare resources. However, during this unprecedented reduction in elective surgery, there is likely to be some controversy as to what constitutes a purely "elective" procedure, versus an "urgent" procedure, particularly regarding hip arthroplasty. We reviewed the available literature for articles discussing the most commonly encountered indications for primary, conversion, and revision hip arthroplasty. Based upon the indications discussed in these articles, we further stratified these indications into "elective" versus "urgent" categories. In patients presenting with hip arthroplasty indications, the decision to proceed urgently with surgery should be based upon (a) the potential harm incurred by the patient if the surgery was delayed and (b) the potential risk incurred by the patient in the context of COVID-19 if surgery was performed. The authors present a decision-making algorithm for determining surgical urgency in three patients who underwent surgery in this context. Urgent total hip arthroplasty in the setting of the COVID-19 pandemic is a complex decision-making process, involving clinical and epidemiological factors. These decisions are best made in coordination with a multidisciplinary committee of one's peers. Region-specific issues such as hospital resources and availability of PPE may also inform the decision-making process.

Surgical automation reduces operating time while maintaining accuracy for direct anterior total hip arthroplasty.

OBJECTIVE: Investigate the efficiency/accuracy of surgical automation versus manual component implantation in DA THA. METHODS: Retrospective review of 111 hips: 51 hips via automation and 60 hips via manual technique for DA THA. RESULTS: OR time averaged 8 min faster in the Automated group, compared to Manual group (p = 0.0009). Average femoral size was one size larger in the Automated group compared to Manual group (p = 0.007). No clinically significant differences were found between Manual and Automated groups for cup position or limb-length discrepancy. One calcar fracture occurred in the Automated group. CONCLUSION: Surgical automation is efficient and accurate for DA THA.

Financial impact of removal of total knee arthroplasty from the inpatient-only list for a physician-owned BPCI program.

OBJECTIVE: Assessing financial effects of removal of TKA from CMS inpatient-only list on physician-owned bundles. METHODS: We determined whether Medicare TKAs remained inpatient, versus changed to observational. We used CMS data to determine savings. Direct costs associated with BPCI were calculated. RESULTS: 7/28 TKAs (25.0%) had inpatient status changed to observational, excluding them from BPCI. Estimated savings losses were $24,332. Direct costs for administrating BPCI were $51,250. Had the rate of patients changed to observational been 50%, bundle savings from remaining patients would be less than direct costs. CONCLUSION: Removing TKA from CMS inpatient-only list may have negative financial implications.

Prospects of modeling poststroke epileptogenesis.

This Review describes the current status of poststroke epilepsy (PSE) with an emphasis on poststroke epileptogenesis modeling for testing new therapeutic agents. Stroke is a leading cause of epilepsy in an aging population. Late-onset "epileptic" seizures have been reported in up to 30% cases after stroke. Nevertheless, the overall prevalence of PSE is 2-4%. Rodent models of stroke have contributed to our understanding of the relationship between seizures and the underlying ischemic damage to neurons. To understand whether acutely generated stroke events lead to a chronic phenotype more closely resembling PSE with recurrent seizures, a limited variety of approaches emerged in early 2000s. These limited methods of causing an occlusion in mice and rats show different infarct size and neurological deficits. The most often employed procedure for inducing focal ischemia is the middle cerebral artery occlusion. This mimics the pathophysiology seen in humans in terms of extent of damage to cortex and striatum. Photothrombosis and endothelin-1 models can similarly evoke episodes of ischemic stroke. These models are well suited to studying mechanisms and biomarkers of epileptogenesis or optimizing novel drug discoveries. However, modeling of PSE is tedious, is highly variable, and lacks validity; therefore, it is not widely implemented in epilepsy research. Moreover, the relevance of ischemic models to specific forms of human stroke remains unclear. Stroke modeling in young male rodents lacks clinical relevance to elderly populations and especially to women, likely as a result of sex differences. Nevertheless, because of the neuronal damage and epileptogenic insult that these models trigger, they are helpful tools in studying acquired epilepsy and prophylactic drug therapy. © 2016 Wiley Periodicals, Inc.

Validation of an HPV16-mediated carcinogenesis mouse model.

BACKGROUND/AIM: Human papillomavirus Type 16 (HPV16) infection is a necessary but alone insufficient cause of invasive cervical cancer (ICC) and likely causes other genital cancers. Individual genetic variability influences the natural history of the neoplasm. Developing a variety of animal models to investigate HPV16-mediated carcinogenesis is important to Phase 1 trials for human cancer treatments. MATERIALS AND METHODS: C57BL/6 mice expressing the HPV16-E7 transgene were treated with 100 nmoles of 7,12-dimethylbenz(a)anthracene (DMBA) on dorsal-thoracolumbar skin for ≤20 weeks. RESULTS: Transgenic-HPV16E7 mice showed more tumors (14.11±1.49 vs. 7.2±0.73) that more quickly reached maximal size (17.53±0.53 vs. 28.75±0.67 weeks) than syngeneic controls. CONCLUSION: DMBA topically-treated C57BL/6-HPV16E7 mice developed chronic inflammation as well as benign and malignant lesions, many of which ulcerated. Histology showed that the HPV16-E7 transgene more than doubled the effect of complete carcinogenesis against a C57BL/6 background alone, strongly influencing the number, size, and time-to-maximal tumor burden for DMBA-exposed transgenic-C57BL/6 mice.