Patient-reported outcomes after above-knee amputation for prosthetic joint infection.

BACKGROUND: Prosthetic joint infection (PJI) is a challenging complication after total knee arthroplasty (TKA). Above-knee amputation (AKA) is a salvage procedure that may be performed after revision TKAs fail to eradicate PJI. Few studies have investigated patient-reported outcomes. This study investigates patient-reported functional outcomes and overall satisfaction in a cohort of patients who underwent AKA for PJI. METHODS: We performed a retrospective study of all patients who underwent AKA for PJI from 2002 to 2015 at a tertiary academic institution in the rural northeastern United States, along with prospective phone interviews. Functional outcomes and overall satisfaction were adapted from the Above-The-Knee Amputation Functional Ability Questionnaire. Additional variables included age, sex, American Society of Anesthesiologists (ASA) Score, and mortality. RESULTS: Forty-four patients were included in the study. Eighteen patients died prior to study initiation, with a mean time of 948 days (2.6 years) between AKA and death. The 5-year mortality rate was 50%. Among the 14 patients who completed the survey, 12 (86%) were fit for prosthesis following AKA. Of these, 10 (71%) required the use of an assistive device and one (seven percent) reported being functionally independent with their prosthesis. Five (36%) required further surgery after their AKA. Twelve (86%) stated that they were satisfied with their AKA and 5 (42%) would have done it sooner if offered. CONCLUSIONS: Patients who underwent AKA for PJI reported a low level of independence and ability to ambulate with a high mortality rate. However, most were satisfied with their AKA and would choose it again.

Correlation of multiple patient-reported outcome measures across follow-up in patients undergoing primary shoulder arthroplasty.

BACKGROUND: Multiple validated outcome scores are used to assess patients undergoing shoulder arthroplasty. The purpose of this study was to determine whether a correlation exists between 3 commonly used patient-reported outcome (PRO) measures in this population: Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Assessment Form, and Simple Shoulder Test (SST). METHODS: We performed a retrospective review of a shoulder arthroplasty database that routinely collects SPADI, ASES, and SST scores at each visit prospectively. Patients undergoing primary shoulder arthroplasty were identified. Assessments of correlation coefficients (Pearson correlation coefficient for ASES and SPADI scores and Spearman correlation coefficient for SST score) between each combination of PROs were performed overall and at each time point (preoperatively and 3, 6, 12, and 24 months postoperatively) to determine the level of association between PROs. RESULTS: In total, 848 shoulder arthroplasty procedures were performed in 754 patients with 2796 unique clinical encounters. Preoperative correlations among PROs were moderate to strong (range, 0.66-0.77) but had the lowest correlation among all comparisons. Postoperative correlations were strong for all PRO comparisons (range, 0.73-0.94). Postoperative PRO correlations continued to strengthen over longer follow-up, with all values exceeding 0.78 at 2 years postoperatively. Conversion equations between PROs were calculated based on these highly correlated data. CONCLUSION: After primary shoulder arthroplasty, there exists a high degree of correlation among all 3 studied PROs. Correlations were stronger postoperatively and improved with longer follow-up. Surgeons may use this information to minimize the number of questionnaires patients answer at each follow-up time point, and the conversion equations can be used for study comparison in meta-analyses.

Managing Glenoid Bone Deficiency-The Augment Experience in Anatomic and Reverse Shoulder Arthroplasty.

Glenoid bone deficiency in the setting of shoulder replacement surgery is far more common than originally reported. The frequency and severity of the glenoid defects are noted to be more common and severe with the advent of computer-assisted surgery. The results of an anatomic total shoulder arthroplasty (aTSA) with glenoid deficiency have been reported to be inferior to aTSA patients without a glenoid deficiency. Options for treating the glenoid deficiency include eccentric reaming, bone grafting, and the use of augmented glenoid components. The purpose of this article is to present the indications, technique, and results of augmented glenoids for both aTSA and reverse TSA (RTSA). Augments for both aTSA and RTSA are viable options. They preserve subchondral bone at the same time as optimizing the joint line without the need for bone grafts. Complications, revisions and results are as good as compared to shoulder arthroplasties without glenoid wear.

Anatase titanium dioxide nanoparticles in mice: evidence for induced structural and functional sperm defects after short-, but not long-, term exposure.

Titanium dioxide (TiO 2 ) nanoparticles (TNPs) are widely used commercially and exist in a variety of products. To determine if anatase TNPs (ATNPs) in doses smaller than previously used reach the scrotum after entry in the body at a distant location and induce sperm defects, 100% ATNP (2.5 or 5 mg kg-1 body weight) was administered intraperitoneally to adult males for three consecutive days, followed by sacrifice 1, 2, 3, or 5 weeks later (long-) or 24, 48 or 120 h (short-term exposure). Transmission electron microscopy revealed the presence of ANTP in scrotal adipose tissues collected 120 h postinjection when cytokine evaluation showed an inflammatory response in epididymal tissues and fluid. At 120 h and up to 3 weeks postinjection, testicular histology revealed enlarged interstitial spaces. Significantly increased numbers of terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling-positive (apoptotic) germ (P = 0.002) and interstitial space cells (P = 0.04) were detected in treated males. Caudal epididymal sperm from the short-term, but not a long-term, arm showed significantly (P < 0.001) increased frequencies of flagellar abnormalities, excess residual cytoplasm (ERC), and unreacted acrosomes in treated versus controls (dose-response relationship). A novel correlation between ERC and unreacted acrosomes was uncovered. At 120 h, there were significant decreases in hyperactivated motility (P < 0.001) and mitochondrial membrane potential (P < 0.05), and increased reactive oxygen species levels (P < 0.00001) in treated versus control sperm. These results indicate that at 4-8 days postinjection, ANTP induce structural and functional sperm defects associated with infertility, and DNA damage via oxidative stress. Sperm defects were transient as they were not detected 10 days to 5 weeks postinjection.