The Utilization of Press-Fit Total Knee Arthroplasty is Not Evenly Distributed: A National Registry Review.

BACKGROUND: This study evaluates trends of cemented versus press-fit total knee arthroplasty (TKA). We hypothesized that press-fit TKA is more common in younger and obese patients. There may also be racial, geographic, and institutional variation. METHODS: The American Joint Replacement Registry was used to conduct a retrospective review of primary TKA procedures for osteoarthritis in the United States between January 2019 and March 2022. The objective was to identify differences in incidence, demographics, body mass index (BMI), Charlson Comorbidity Index (CCI), and institutional teaching status (teaching vs. non-teaching) between press-fit and cemented TKAs. RESULTS: Two hundred ninety-seven thousand four hundred two patients (61% female, average age 68 years, 88.3% White) underwent cemented TKA versus 50,880 patients (52% female, average age 65 years, 89% White) underwent press-fit TKA. Overall, 20.8% of press-fit versus 19.9% of cemented TKA had a BMI of 35 to 39.9 and 15.2% of press-fit versus 12.5% of cemented TKA had BMI >40 (P < 0.001). Patients undergoing press-fit TKA were less likely Black (OR = 0.727; P < 0.0001), Asian (OR = 0.651, P < 0.0001), and Native Hawaiian/other Pacific Islander (OR = 0.705, P < 0.02) with White as the reference group. Northeastern and Southern United States were more likely to use press-fit TKA than the Midwest (OR = 1.89 and OR = 1.87, P < 0.0001) and West (OR = 1.67; and OR = 1.65; P < 0.0001). Press-fit TKA incidence in 2019 was 9.9% versus 20.6% in 2022 (P < 0.001). CONCLUSION: Press-fit TKA is increasingly more common in Northeastern and Southern United States, and patients are older than expected. Patients with BMI >35 had a slightly higher rate of undergoing press-fit than cemented TKA. Notable racial differences also exist. Additional research addressing racial disparities and evaluating longevity of press-fit designs is needed.

Robotic-assisted TKA is Not Associated With Decreased Odds of Early Revision: An Analysis of the American Joint Replacement Registry.

BACKGROUND: Robotic-assisted TKA continues to see wider clinical use, despite limited knowledge of its impact on patient satisfaction and implant survival. Most studies to date have presented small cohorts and came from single-surgeon or single-center experiences. Therefore, a population-level comparison of revision rates between robotic-assisted and conventional TKA in the registry setting may help arthroplasty surgeons better define whether robotic assistance provides a meaningful advantage compared with the conventional technique. QUESTIONS/PURPOSES: (1) After controlling for confounding variables, such as surgeon, location of surgery, and patient comorbidity profile, were robotic-assisted TKAs less likely than conventional TKAs to result in revision for any reason at 2 years? (2) After again controlling for confounding variables, were robotic-assisted TKAs less likely to result in any specific reasons for revision than the conventional technique at 2 years? METHODS: The American Joint Replacement Registry was used to identify patients 65 years or older who underwent TKA between January 2017 and March 2020 with a minimum of 2 years of follow-up. Patients were limited to age 65 yeas or older to link TKAs to Medicare claims data. Two retrospective cohorts were created: robotic-assisted TKA and conventional TKA. Patient demographic variables included in the analysis were age, gender, BMI, and race. Additional characteristics included the Charlson comorbidity index, anesthesia type, year of the index procedure, and length of stay. A total of 10% (14,216 of 142,550) of TKAs performed during this study period used robotics. Patients with robotic-assisted TKA and those with conventional TKA were similar regarding age (73 ± 6 years versus 73 ± 6 years; p = 0.31) and gender (62% [8736 of 14,126] versus 62% [79,399 of 128,334] women; p = 0.34). A multivariable, mixed-effects logistic regression model was created to analyze the odds of all-cause revision as a factor of robot use, and a logistic regression model was created to investigate specific revision diagnoses. RESULTS: After controlling for potentially confounding variables, such as surgeon, location of surgery, and Charlson comorbidity index, we found no difference between the robotic-assisted and conventional TKAs in terms of the odds of revision at 2 years (OR of robotic-assisted versus conventional TKA 1.0 [95% CI 0.8 to 1.3]; p = 0.92). The reasons for revision of robotic-assisted TKA did not differ from those of conventional TKA, except for an increased odds of instability (OR 1.6 [95% CI 1.0 to 2.4]; p = 0.04) and pain (OR 2.1 [95% CI 1.4 to 3.0]; p < 0.001) in the robotic-assisted cohort. CONCLUSION: In light of these findings, surgeons should not assume that robotic assistance in TKA will lead to improved early implant survival. Our findings do not support an improvement over conventional TKA with robotic assistance with regards to common causes of early revisions such malalignment, malposition, stiffness, pain, and instability, and in some cases, suggest there is a benefit to conventional TKA. Differences in the mid-term and long-term revision risk with conventional versus robotic-assisted TKA remain unknown. Appropriate informed consent around the use of robotic assistance should not imply decreased early revision risk. LEVEL OF EVIDENCE: Level III, therapeutic study.

Regional Trends in Unicondylar and Patellofemoral Knee Arthroplasty: An Analysis of the American Joint Replacement Registry.

BACKGROUND: As the popularity of unicondylar knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) have expanded, more patients who have limited arthritis are undergoing partial knee arthroplasty. No studies have evaluated if any regional differences in the United States (U.S.) exist between partial versus total knee arthroplasty (TKA). The purpose of this study was to utilize the American Joint Replacement Registry to evaluate regional differences in UKA, PFA, and TKA. METHODS: The American Joint Replacement Registry was queried for all TKA, PFA, and UKA procedures between 2012 and 2021. Surgical volume was compared between the Midwest (MW), Northeast (NE), South, and West (W) regions. Trends were compared using multivariate logistic regression analyses and least squared mean logistic regression models. RESULTS: Since 2012, there has been a steady increase in the amount of UKAs performed across the U.S., except during the COVID-19 pandemic when numbers decreased. Logistic regression analyses demonstrated a higher likelihood of receiving a UKA compared to TKA in the NE compared to other regions, and higher likelihood of receiving a PFA in the NE and W compared to other regions over the study period. Other factors that increased the likelihood of having a UKA nationally were men, the procedure being performed at a teaching hospital, and having surgery in urban areas. Patients were more likely to have a PFA in the NE compared to the S and MW, and higher odds in the South and W compared to the MW, with rates of PFA consistently lower in the MW compared to other regions. CONCLUSIONS: Patients were more likely to have a UKA in the NE compared to other regions of the country. Patients had higher odds of having a PFA in the NE and W regions relative to the MW. Men had higher odds of having either UKA or PFA than women across the nation.

Catalytic generation of ortho-quinone dimethides via donor/donor rhodium carbenes.

Substrates engineered to undergo a 1,4-C-H insertion to yield benzocyclobutenes resulted in a novel elimination reaction to yield ortho-quinone dimethide (o-QDM) intermediates that undergo Diels-Alder or hetero-Diels-Alder cycloadditions. The analogous benzylic acetals or ethers avoid the C-H insertion pathway completely and, after hydride transfer, undergo a de-aromatizing elimination reaction to o-QDM at ambient temperature. The resulting dienes undergo a variety of cycloaddition reactions with high diastereo- and regio-selectivity. This is one of the few examples of catalytic generation of o-QDM without the intermediacy of a benzocyclobutene and represents one of the mildest, ambient temperature processes to access these useful intermediates. This proposed mechanism is supported by DFT calculations. Moreover, the methodology was applied to the synthesis of (±)-isolariciresinol in 41% overall yield.

Do parent and self-report rating scales of executive function measure the same constructs with adolescents?

OBJECTIVE: There are numerous measures of executive function (EF), yet the multiple definitions and constructions of EF suggest that these measures may not be measuring the same construct or domains within EF. The purpose of this study was to examine the concurrent validity of the BRIEF and the CEFI parent and self-report forms with adolescents. METHOD: Adolescent participants, ages 12-17 years, were recruited using a snowball method with recruitment targeting individuals from under-represented groups, as well as the general population. The resulting sample consisted of 52 cases with parent report. The adolescents were predominantly female (55.77%) and white (40.38%) with a mean age of 14.56 (1.72). RESULTS: For parent and adolescent self-report on both the BRIEF and CEFI, mean global scores were within the average range. To examine whether the two rating scales were measuring the same underlying constructs of EF, a multi-trait-multi-method (MTMM) model was conducted using correlated traits correlated methods (CTCM) and correlated traits uncorrelated methods (CTUM). CONCLUSION: While the global scores obtained for the instruments measure EF similarly, there is less consistency in how the subdomains parse out and are labeled for each of the two scales. Implications for practice are discussed.

Seroprevalence of porcine reproductive and respiratory syndrome virus on swine farms in a tropical country of the Middle Americas: the case of Costa Rica.

Porcine reproductive and respiratory syndrome virus (PRRSV) causes significant economic losses to the swine industry worldwide. Little is known regarding the epidemiology of this infection in tropical countries. To address this problem in Costa Rica, a seroepidemiological study was carried out in two phases. In the first phase, a pilot study was conducted in nine farms with the clinical diagnosis of PRRSV. In total, 265 pig serum samples were collected from animals ranging in age from 1 to 15 weeks of age. This study aimed to establish the duration of maternal immunity in piglets, to identify the period of viremia, and to determine when seroconversion occurs. In the second phase, a cross-sectional serology study was performed on a representative sample of the Costa Rican national herds in the second phase. The twenty-five selected farms represent all provinces and were classified according to herd size (100 to 2000 sows). In each farm, pigs aged 8, 10, and 12 weeks were sampled, as well as gilts based on the pilot study. In total 1281 pigs were sampled across all 25 farms. The aim of the cross-sectional study was to quantify the seroprevalence of PRRSV in Costa Rican pig farms and to describe its geographical distribution in this tropical country. The prevalence of positive farms was 44% (11/25), and these farms were located in six of the seven provinces of Costa Rica. Overall, 58% (344/596) of the pigs were seropositive to PRRSV. The age of the pigs and the ecozone where farms were located were significantly related with PRRSV seroprevalence in animals and herds, respectively.

Analysis of ORF5 sequences of Porcine Reproductive and Respiratory Syndrome virus (PRRSV) circulating within swine farms in Costa Rica.

BACKGROUND: Worldwide, Porcine Reproductive and Respiratory Syndrome (PRRS) is among the diseases that cause the highest economic impact in modern pig production. PRRS was first detected in Costa Rica in 1996 and has since then severely affected the local swine industry. Studies of the molecular characterization of circulating strains, correlation with clinical records, and associations with pathogens associated with Porcine Respiratory Disease Complex (PRDC) have not been done in Costa Rica. RESULTS: Sequencing and phylogenetic analysis of ORF5 proved that PRRSV-2 was the only species detected in all locations analyzed. These sequences were grouped into three clusters. When comparing samples from San Jose, Alejuela, and Puntarenas to historical isolates of the previously described lineages (1 to 9), it has been shown that these were closely related to each other and belonged to Lineage 5, along with the samples from Heredia. Intriguingly, samples from Cartago clustered in a separate clade, phylogenetically related to Lineage 1. Epitope analysis conducted on the GP5 sequence of field isolates from Costa Rica revealed seven peptides with at least 80% amino acid sequence identity with previously described and experimentally validated immunogenic regions. Previously described epitopes A, B, and C, were detected in the Santa Barbara-Heredia isolate. CONCLUSIONS: Our data suggest that the virus has three distinct origins or introductions to the country. Future studies will elucidate how recently introduced vaccines will shape the evolutionary change of circulating field strains.