Risk factors for revision of total knee arthroplasty: a scoping review.

BACKGROUND: In spite of the increasing incidence of total knee arthroplasties (TKA), evidence is limited regarding risk factors for revision. The objective of this scoping review was to identify and assess demographic, surgical and health services factors that may increase the risk for revision surgery following TKA. METHODS: A scoping review was undertaken following an electronic search in MEDLINE (1990 to December 2013), CINAHL (to December 2013), EMBASE (1990 to December 2013) and Web of Science (1990 to December 2013). RESULTS: Of the 4460 articles screened, 42 were included of which 26 articles were based on registry data. Increased risk of revision was associated with demographic factors (younger age, African American), surgical factors related to the primary TKA (uncemented components, implant malalignment, increased surgery duration), and health services (low volume hospitals). CONCLUSIONS: Identifying emerging trends in characteristics of those requiring revision following TKA can help identify those at risk and allocate appropriate resources. Further primary clinical articles on risk factors for revision of TKA are necessary to ensure maximal function and lifespan following TKAs.

Subcutaneous open-loop insulin delivery for type 1 diabetes: Paradigm Real-Time System.

(1) An open-loop insulin delivery system combines an external insulin pump with continuous monitoring of glucose levels via a subcutaneous sensor. The sensor communicates glucose readings to the pump using a radio transmitter. (2) In four small, comparative studies, adults and children with poorly controlled type 1 diabetes who were randomized to use the Paradigm Real-Time System had clinically important improvements in A1c (a measure of average glycemic control over the previous three months) compared to baseline. (3) Some studies found greater improvements in A1c and less hypoglycemia with the Paradigm Real-Time System compared to multiple daily insulin injections or pump therapy combined with conventional glucometer readings. (4) Adverse events with the Paradigm Real- Time System include infection, itching, irritation, and redness at the site of the glucose sensor, and rare instances of insulin pump malfunction. (5) Based on the limited amount of research published to date, the impact of the Paradigm Real-Time System on long-term glycemic control, prevention of diabetic complications, or quality of life is unclear.