Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation.

Surgical site infections (SSIs) are a significant complications in total knee arthroplasty (TKA). The purpose of this study was to evaluate if traditional vs. single-use instrumentation had an effect on SSI's. We compared SSI rates and costs of TKAs performed with single-use (449) and traditional (169) TKA instrumentation trays. Total OR Time was, on average, 30 min less when single-use instrumentation was used. SSIs decreased in the single-use group (n=1) compared to the traditional group (n=5) (P=0.006). Single-use instrumentation added $490 in initial costs; however it saved between $480 and $600. Single-use instrumentation may provide a benefit to the patient by potentially decreasing the risk of infection and reducing the overall hospital costs.

Concussions From 9 Youth Organized Sports: Results From NEISS Hospitals Over an 11-Year Time Frame, 2002-2012.

BACKGROUND: Youth sports programs are extremely popular throughout the United States, with children starting formal sports participation as young as 4 years. This places children at greater risk for concussions and other trauma. PURPOSE: To describe the epidemiology of concussions sustained during participation in 9 organized sports prior to participation in high school athletics. METHODS: Over an 11-year span from January 2002 to December 2012, the authors reviewed the concussions sustained by athletes aged 4 to 13 years while playing basketball, baseball, football, gymnastics, hockey, lacrosse, soccer, softball, and wrestling, as evaluated in emergency departments (EDs) in the United States and captured by the National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission. STUDY DESIGN: Descriptive epidemiology study. RESULTS: There were 4864 (national estimate [NE] = 117,845) youth athletes evaluated in NEISS EDs as sustaining concussions from 2002 to 2012. Except for the year 2007, concussion frequencies trended upward throughout the 11-year time frame as well as with increasing age. Loss of consciousness (LOC) occurred in 499 cases (NE, 12,129; 10%). Football had the highest frequency of concussions, with 2013 (NE, 51,220; 41%), followed by basketball, with 977 (NE, 22,099; 20%), and soccer, with 801 (NE, 18,916; 17%). The majority of concussions were treated in the outpatient setting, with 4444 (91.4%) patients being treated and released; 412 (9%) patients required admission and were found to have increased frequencies of LOC (n = 17; 18.0%) compared with LOC in the total group (n = 499, 10%). The total number of player-to-player injury mechanisms mirrored the total number of concussions by year, which increased throughout the 11-year span, except for the year 2007. Subgroup analysis of athletes aged 4 to 7 years demonstrated a difference in the mechanism of injury distribution, with a ball-to-head mechanism increase of 5% from 15% to 20% and a player-to-other object mechanism of injury increase by more than double to 13% compared with the entire cohort over the 11-year time frame. CONCLUSION: Within the 4- to 13-year age range, there were a significant number of young athletes who presented to EDs with concussion as a result of playing organized sports. The 4- to 7-year age group had a disproportionately higher player-to-other object mechanism of injury. CLINICAL RELEVANCE: Younger children are more susceptible to long-term sequelae from head injuries, and therefore, improved systems of monitoring for these athletes are required to monitor the patterns of injury, identify risk factors, and develop evidence-based prevention programs.

Concussions From Youth Football: Results From NEISS Hospitals Over an 11-Year Time Frame, 2002-2012.

BACKGROUND: Youth football programs across the United States represent an at-risk population of approximately 3.5 million athletes for sports-related concussions. The frequency of concussions in this population is not known. STUDY DESIGN: Descriptive epidemiology study. METHODS: Over an 11-year span from January 2002 to December 2012, the authors reviewed the concussions sustained by athletes aged 5 to 13 years while playing football, as evaluated in emergency departments (EDs) in the United States and captured by the National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission. RESULTS: There were 2028 (national estimate, 49,185) young football players evaluated in NEISS EDs with concussion from 2002 to 2012. There were 1987 (97.9%) males and 41 (2.1%) females, with a mean age of 11.2 years. The total number of concussions reported increased with age and by year. The majority of concussions were treated in the outpatient setting, with 1878 (91.7%) being treated and released. The total number of head-to-head injury mechanisms mirrored the total number of concussions by year, which increased throughout the 11-year span. The total number of players experiencing a loss of consciousness increased throughout the study period but did not match the total number of concussions over the 11-year time period. Fractures occurred in 11 (0.5%) patients, with 2 being severe (1 skull fracture and 1 thoracic compression fracture). CONCLUSION: Within the 5- to 13-year age range, there were a significant number of young athletes who presented to EDs with concussion as a result of playing organized football. Older children may be at greater risk for sustaining concussions, fractures, and catastrophic injuries while playing football when compared with younger children. CLINICAL RELEVANCE: Younger children are more susceptible to long-term sequelae from head injuries, and thus, improved monitoring systems for these athletes are needed to assist in monitoring patterns of injury, identifying risk factors, and driving the development of evidence-based prevention programs.

Epidemiology of cheerleading injuries presenting to NEISS hospitals from 2002 to 2007.

BACKGROUND: Cheerleading has developed into a complex sport utilizing aspects of dance, gymnastics/tumbling, single- and multiple-partner stunts, and tosses in complex displays. Stunting and tosses elevates one or multiple participants into the air supported by teammates putting all at significant injury risk. METHODS: We reviewed all cheerleading injuries captured by the US Consumer Product Safety Commission National Electronic Injury Surveillance System from 2002 to 2007 that presented to US Emergency Departments and used the new narrative feature added in 2002 to better differentiate injury context and severity. RESULTS: There were 4,245 cases of cheerleaders presenting to National Electronic Injury Surveillance System Emergency Departments from 2002 to 2007 with an average age of 14.6 years, and 96.3% were female. Most of these injuries could be treated as outpatients (97.9%). The extremities were most likely affected, 2,610 (61.5%), with further distribution breakdown as follows: upper extremity 1,339 (31.5%), lower extremity 1,271 (29.9%), head and neck 1,085 (25.6%), trunk 491 (11.6%), and other 48.0 (1.1%). The type of injury sustained in descending order is as follows: sprains/strains 1,871 (44.1%), fractures 709 (16.7%), and contusions 684 (16.1%). The most common mechanism of injury was a collision between two or more cheerleaders (1,242; 29.3% overall), followed by stunting (841; 19.8% overall), tumbling (478, 11.3% overall), and tossing (105, 2.5% overall). Subset analysis was performed on fracture, admit, and severe injury groups. CONCLUSIONS: The upper extremity was the most commonly injured part of the body and sustained a significantly greater number of fractures. However, head injuries were more likely to be severe. The value of a more detailed database specific to cheerleading could be invaluable in identifying risk factors and activity-specific injury patterns and facilitate implementing safety measures. LEVEL OF EVIDENCE: III.

Lipopolysaccharide-induced inflammatory cytokine production by Schwann's cells dependent upon TLR4 expression.

Signaling of Toll-like receptor-4 (TLR4) through its cognate ligand endotoxin appears critical in tissue inflammation associated with bacterial infection. We found that anti-GM1 antibody (Ab) enhances TLR4 expression in Schwann's cells (SCs) in vivo and in vitro. The anti-GM1 Ab-treated SC also showed increased release of pro-inflammation cytokines IL-1beta and TNF-alpha after incubation with lipopolysaccharide (LPS). Furthermore, down-regulation of TLR4 expression using antisense oligonucleotides targeted to TLR4 mRNA suppressed cytokine production in LPS stimulated cultures. These findings suggest that elevation of TLR4 expression increases sensitivity of SC to LPS and production of inflammatory mediators that may be responsible for peripheral nerve dysfunction.