Subsequent Revision Research Articles

Uncompromised total knee arthroplasty function after distal femoral osteotomy.

Distal femoral osteotomies (DFOs) are commonly used for the correction of valgus deformities and lateral compartment osteoarthritis. However, the impact of a DFO on subsequent total knee arthroplasty (TKA) function remains a subject of debate. Therefore, the purpose of this study was to determine the effect of a unilateral DFO on subsequent TKA function in patients with bilateral TKAs, using the contralateral knee as a self-matched control group. The inclusion criteria consisted of patients who underwent simultaneous or staged bilateral TKA after prior unilateral DFO between 1972 and 2023. The type of osteotomy performed, osteotomy hardware fixation, implanted TKA components, and revision rates were recorded. Postoperative outcomes including the Forgotten Joint Score-12 (FJS-12), Tegner Activity Scale score, and subjective knee preference were also obtained at final follow-up. A total of 21 patients underwent bilateral TKA following unilateral DFO and were followed for a mean of 31.5 years (SD 11.1; 20.2 to 74.2) after DFO. The mean time from DFO to TKA conversion was 13.1 years (SD 9.7) with 13 (61.9%) of DFO knees converting to TKA more than ten years after DFO. There was no difference in arthroplasty implant systems employed in both the DFO-TKA and TKA-only knees (p > 0.999). At final follow-up, the mean FJS-12 of the DFO-TKA knee was 62.7 (SD 36.6), while for the TKA-only knee it was 65.6 (SD 34.7) (p = 0.328). In all, 80% of patients had no subjective knee preference or preferred their DFO-TKA knee. Three DFO-TKA knees and two TKA-only knees underwent subsequent revision following index arthroplasty at a mean of 12.8 years (SD 6.9) and 8.5 years (SD 3.8), respectively (p > 0.999). In this self-matched study, DFOs did not affect subsequent TKA function as clinical outcomes, subjective knee preference, and revision rates were similar in both the DFO-TKA and TKA-only knees at mean 32-year follow-up.

Regulatory options for cultivars and hybrids of invasive plant species – the South African experience

Abstract Invasive plant taxa are generally regulated at the species level, without considering infra- or inter-specific variation. However, cultivars or hybrids can be of a lower level of risk, e.g., due to sterility. We evaluate six general approaches to regulating cultivars and hybrids -1) “Globally guilty by association”; 2) “Nationally guilty by association”; 3) “Guilty until proven innocent”; 4) “Negotiated guilt”; 5) “Claimed to be innocent”; and 6) “Innocent until proven guilty”. We discuss these approaches in the context of South Africa (which has a typified “Negotiated guilt” approach). Following negotiations since 2001 between the South African horticultural industry/green industry and legislators, an unofficial consensus list of “presumed sterile” cultivars and hybrids was produced in 2014 containing 187 entities from 34 taxa. In 2020 this was reduced to 157 entities from 16 taxa. But the evidence supporting the original lists and the subsequent revisions were not published. To address this issue, we developed a generic pro-forma for reporting sterility based on observations and/or experiments on: flowering, fruiting, pollen, and seeds; the potential for vegetation propagation; and the potential for genetic changes (including hybridisation and reversion to fertility). We recommend that such information should be incorporated into risk analyses conducted specifically for infra- and inter- specific entities, and only if the risk of a harmful invasion is demonstrated to be acceptably low or can be easily mitigated should such entities be exempted from regulation. This will be time-consuming, but by setting out the evidence clearly, the approach is transparent and provides a clear route for stakeholders to seek exemptions for entities of importance. In summary, although we suspect the simplicity of the “Negotiated guilt” approach is desirable to many stakeholders; in general, and specifically for South Africa, we recommend a shift towards the “Guilty until proven innocent” approach.

Outcomes of integrated knowledge translation: A comparative, multi-country case study

Abstract Background Integrated knowledge translation (IKT) seeks to establish continuous relationships between researchers and knowledge users, in particular decision-makers, to enhance evidence-informed decision-making in public health and healthcare. IKT is, however, difficult to evaluate and outcome evaluations remain scarce. The German-African Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) undertook research on IKT and non-communicable diseases in Ethiopia, Malawi, Rwanda, South Africa, and Uganda. Over six years, we implemented an IKT approach and evaluated it according to a pre-defined programme theory. Methods We conducted qualitative interviews and surveys with CEBHA+ researchers and their decision-making partners at two stages (3/2020-2/2021; 9/2022-5/2023) and collected IKT-related documents (see protocol: https://rdcu.be/dyfBP). Transcripts and documents were analysed using qualitative content analysis and surveys were analysed descriptively, with subsequent integration, cross-case analysis, and revision of the programme theory. Results We collected 92 IKT-related documents; and 55 researchers and decision-makers participated in surveys, focus groups or interviews. Proximal outcomes were collaborative research; capacity-building related to research skills and evidence use; and relationship-building, establishing trust and partnerships. Intermediate outcomes were changes in attitudes and knowledge; decision-makers became attuned to research and researchers increased their understanding of the decision-making context, and developed a vision for research impact. Distal outcomes were the production of applicable research and the consideration of evidence by decision-makers. High opportunity costs associated with IKT implementation constituted unintended effects. Conclusions Our study presents rich, theory-informed insights into IKT outcomes, based in particular on the experience of researchers implementing the CEBHA+ IKT approach. Key messages • A multi-country research collaboration offered an opportunity to examine IKT implementation and investigate proximal, intermediate, and distal IKT outcomes based on a pre-defined programme theory. • Beyond our initial conceptualisation, the IKT approach was linked to researchers developing a vision for ‘research impact’ and gaining a better understanding of the decision-making context.

Scar revision for persistent pain and activity limitation after exploratory laparotomy in infancy: A case series

AbstractExploratory laparotomy in neonates is typically performed via a transverse laparotomy incision. However, this incision may be complicated by poor cosmesis and scar contracture. In three patients, primary gastroenterologists identified significant scar contractures that resulted in pain and limitations with physical activity, necessitating surgical referrals. All patients required subsequent surgical revision of their scar, which involved creation of skin flaps, repair of abdominal wall hernias if present, and reapproximation of the subcutaneous tissue. We describe this phenomenon and the resultant need for surgical management to raise awareness of these late complications and suggest subcutaneous tissue reapproximation should be performed when possible during abdominal wall closure.

Utility of routine postoperative imaging in adults undergoing primary ventriculoperitoneal shunts.

There is currently no consensus on the usefulness of postoperative imaging after ventriculoperitoneal (VP) shunt insertion in adults. The aim of this study was to investigate the utility of routine postoperative imaging (CT head scans and radiographs) following primary VP shunt insertion in a general adult population treated at a tertiary neurosurgical centre. Patients undergoing primary VP shunt insertion between 2017-2021 were included. Actions taken based on routine postoperative imaging and need for subsequent shunt revision were recorded. 236 patients were included. The median age was 63years (range 17-90). There was a slight female preponderance (121/236, 51.3%). The median follow-up was 38.5months (3.1 - 60.5months). Acute intervention was employed in 9 patients (3.9%) on the basis of routine postoperative CT head scan. Routine postoperative radiographs did not result in reoperation. Around a quarter (28.8%) of patients had a shunt revision, most of whom underwent urgent primary shunt insertions. Postoperative ventricular catheter characteristics (position of shunt tip, tip relation to septum pellucidum, and intraventricular catheter distance) were not predictive of shunt revision. Surgical urgency (emergency vs. elective procedures) was associated with long-term shunt revision (OR = 2.80, 95% CI 1.42 - 5.53, p = 0.003). Routine postoperative imaging rarely led to reoperation in adult patients undergoing primary VP shunt insertion. Patients undergoing emergency shunt insertions were at the highest risk for requiring revision.

The recipe to sweet success: competitive advantages for a Spanish chocolatier, 1874–1910

Purpose The purpose of this paper is to unravel the success story of a family business, while engaging with debates in business and management research through the application of corporate strategy frameworks. Implement a structured methodology to evaluate a company’s strategic efforts and explore how businesses historically achieved competitive advantages over time. Design/methodology/approach This company analysis adopts a longitudinal approach on competitive advantages, moving beyond traditional cross-sectional business to transform static models into dynamic ones. It adheres to Michael Porter’s Value Chain model (1985) and his subsequent revisions (1996, 2001) to explore how competitive advantages emerge and are sustained. Data exploration leverages an extensive archival corporate collection comprising approximately 100,000 documents, enabling a thorough examination of value chain activities through primary and secondary sources. Findings Chocolates Amatller effectively channelled its competitive advantages through strategic operational areas, including purchasing cocoa at prices below market value, using strong marketing tools such as illustrative collectible cards and posters and implementing skilful financial strategies. Originality/value Examine why, when and how a Spanish chocolatier achieved a position of prominence among Spain’s foremost industrial figures by constructing Barcelona’s iconic Casa Amatller.

Three-year results of XEN gel stent implantation in the treatment of glaucoma

Objective: To evaluate the long-term efficacy and safety of XEN gel stent implantation in patients with refractory glaucoma. Methods: A retrospective case series study was conducted. Clinical data were collected from patients who received medical treatment at the First Affiliated Hospital of Fujian Medical University between January 2020 and September 2020 and underwent XEN gel stent implantation by the same surgeon. Preoperative and postoperative clinical parameters, including the intraocular pressure (IOP), number of ocular hypotensive medications, best-corrected visual acuity, surgical success rates, status of filtering blebs, and complications, were recorded at 1 day, 1 week, 1, 2, 3, 6, 12, 18, 24, and 36 months after surgery. Statistical analyses were performed using the analysis of variance (ANOVA), the least significant difference (LSD) method, and the Fisher's precision probability test. Results: A total of 8 patients (8 eyes) with glaucoma meeting the criteria were included, consisting of 6 males (6 eyes) and 2 females (2 eyes). The preoperative IOP reached (30.88±12.17) mmHg (1 mmHg=0.133 kPa), and the IOP at all postoperative follow-up time points was significantly lower than the preoperative value (P<0.05). At 3 years after surgery, the IOP was (14.38±1.60) mmHg, with a reduction of 53.43% [(16.50±12.07) mmHg]. Only 2 patients required monotherapy for IOP control, and there was no significant decline in best-corrected visual acuity in 7 patients. The surgical outcome at 3 years postoperatively was a complete success in 6 patients, a qualified success in 1 patient, and a failure in 1 patient. The filtering blebs were generally flat and diffuse, with only mild to moderate vascularization. One patient presented elevated IOP at 3 months, and after a subsequent revision of the XEN gel stent, the IOP became stable with the administration of travoprost eye drops. Conclusion: The XEN gel stent implantation proved to effectively reduce the IOP in glaucoma patients, with a high degree of safety demonstrated up to 3-year long-term follow-up.

DIRECT ANTERIOR SURGICAL APPROACH FOR TOTAL HIP ARTHROPLASTY AS AN ALTERNATIVE TO THE DIRECT LATERAL APPROACH

The frequency of total hip arthroplasty (THA) is continuously increasing. Currently, efforts are underway to improve the efficiency of this surgery, making the choice of surgical approach a key factor in its success. The direct anterior approach is gaining popularity due to faster patient recovery, but its advantages and disadvantages compared to the direct lateral approach are not yet fully understood. Objective. To compare the outcomes of the direct anterior and direct lateral approaches in primary total hip arthroplasty, as well as to identify ways to improve the results of THA performed using the direct anterior approach. Methods. A literature search was conducted in three bibliographic databases: PubMed, Scopus, and Web of Science. Results. The direct anterior approach has been found to reduce postoperative pain, blood loss, the likelihood of periprosthetic infection, and hospital stay duration. However, there is an increased risk of dislocation and revision surgery. Several randomized controlled trials have been cited, studying issues related to effective pain management, wound healing, prevention of lateral femoral cutaneous nerve injury, blood loss, prosthetic stem design, specific surgical techniques, equipment selection, early mobilization after THA, and the use of modern software for THA planning. Conclusions. The literature review revealed that patients who underwent THA via the direct anterior approach experienced less postoperative pain. The shorter incision associated with this approach also reduces intraoperative blood loss and periprosthetic infection rates. However, the risk of dislocation and subsequent revision surgeries increases, as does the incidence of nerve paralysis due to lateral femoral cutaneous nerve injury.

Lost species, neglected taxonomy, and the role of natural history collections and synonymization in the identification of the World’s forgotten biodiversity

A recent paper highlighted the need for increased attention towards species that have vanished from scientific literature and proposed a new nomenclature in view of needed conservation actions, based on the time interval since their disappearance. Here, we propose to implement this concept by showcasing a taxonomic perspective that is often overlooked in conservation studies. In recent decades, research on vertebrates showed that, in several cases, species considered as undescribed were, in fact, first discovered and already named a long time ago. Quite often they fell into oblivion while being considered synonyms of other taxa until they were re-evaluated in subsequent taxonomic revisions. In this context, we are proposing the concept of “long-lost synonymized” species, asking for greater attention to the discipline of taxonomy, the relevance of specimen-based taxonomy and the value of natural history collections within conservation and academic communities.

Patient-Reported Outcome Measures After Direct Anterior Total Hip Arthroplasty Are Comparable Between Patients With Rheumatoid Arthritis and Osteoarthritis: A Propensity-Matched Analysis

Introduction: It is currently unclear whether patients with rheumatoid arthritis have similar functional outcomes after total hip arthroplasty (THA) as those with osteoarthritis, particularly given that rheumatoid arthritis may have systemic manifestations in terms of pain and function. The purpose of this study was to compare patient-reported outcome measures between patients with rheumatoid arthritis and matched control patients with osteoarthritis who underwent direct anterior THA. Methods: All patients who underwent direct anterior THA from 2010 to 2022 at a single academic institution were retrospectively reviewed. Hips with rheumatoid arthritis were propensity matched to hips with osteoarthritis on a 1:4 basis. Patient-reported outcome measures, including visual analog scale (VAS) pain at rest and with use, Hip Disability and Osteoarthritis Outcome Score Pain, and Forgotten Joint Score-12, were obtained at follow-up. In addition, modified Harris Hip Scores (mHHS) were obtained both preoperatively and at the final follow-up. Results: Forty-six hips with rheumatoid arthritis and 184 hips with osteoarthritis were followed for a mean of 6.3 ± 3.6 years. Both cohorts demonstrated notable preoperative to postoperative improvements in mHHS (P &lt; 0.001). No differences were observed at the final follow-up between cohorts for VAS at rest (0.8 vs. 0.5, P = 0.333), VAS with use (1.3 vs. 0.9, P = 0.234), Hip Disability and Osteoarthritis Outcome Score Pain (90.4 vs. 93.6, P = 0.113), Forgotten Joint Score-12 (80.3 vs. 82.8, P = 0.529), and mHHS (86.9 vs. 89.0, P = 0.335). One patient with rheumatoid arthritis had an intraoperative periprosthetic calcar fracture, whereas none underwent subsequent revision THA. Conclusion: Patients with rheumatoid arthritis and osteoarthritis who underwent direct anterior THA achieved comparable outcomes in this propensity-matched analysis. Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA.

Systematic Review of the Profunda Artery Perforator Free Flap for Head and Neck Reconstruction.

The profunda artery perforator (PAP) flap has gained popularity in head and neck reconstruction with a favorable donor site providing a relatively hidden scar and the ability to harvest a large amount of pliable tissue with consistent vascular anatomy. The primary aim of this study is to evaluate the safety and efficacy of this PAP flap in head and neck reconstruction. PUBMED, EMBASE, Web of Science, Google Scholar (January 1948-February 2022). A systematic review of the English language literature was conducted for studies with at least 3 patients 18 years or older undergoing head and neck reconstruction utilizing the PAP. Study quality and risk of bias were evaluated using the MINORS scoring system. Main analysis endpoints were flap failure rate, donor site morbidity, and complication rate. Nine articles and 206 total PAP flaps were included. The rate of flap-related and medical complications was 33%, with only 2 (0.97%) instances of complete flap failure. Other complications included partial flap failure (10, 4.86%) and donor site wound complications (12, 5.83%). A total of 16 flaps (7.77%) required subsequent revision in the operating room. Average MINORS score of the studies suggested a moderate to high risk of bias. Based on limited quality evidence, this review suggests that the PAP flap is a safe and feasible tool for head and neck reconstruction, with comparable complication and success rates as other free flaps. Further large-scale studies are warranted.

Essential core competencies for health policy graduates: a multi-method consensus type study

BackgroundIn light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions.MethodsThe study was conducted in three phases: a scoping review, qualitative interviews and the validation of identified competencies through brainstorming with experts. In the initial phase, a scoping review was conducted on the databases. The following databases were searched: PubMed, Scopus, Web of Science and Google Scholar search engine. Additionally, the WebPages of universities offering health policy programmes were manually searched. In the second phase, 36 semi-structured interviews were conducted with students, graduates and distinguished academics from Iran and other countries. These interviews were conducted in person or via email. In the third phase, the draft version of the competencies and their associated learning objectives, derived from the preceding stages, was subjected to independent review by an expert panel and subsequently discussed. In light of the expert panel’s findings, the authors undertook a subsequent revision of the list, leading to the finalization of the core competencies through a process of consensus.ResultsIn the scoping review phase, the analysis included six studies and nine university curricula. The results of the scoping review could be classified into five domains: health system understanding, health policy research, knowledge translation, multidisciplinary work and knowledge of public health. In the second phase, six core competencies were extracted from the interviews and combined with the results of the first phase, which were then discussed by the expert panel at the third phase. The final five core competencies, derived from the brainstorming session and presented in no particular order, encompass health policy research, policy analysis, educational competencies, decision-making and multidisciplinary work.ConclusionsIt is essential that the curriculum is appropriate and contextually tailored, as this is crucial to foster multi-dimensional competencies that complement the specific disciplines of future health policy scholars. These scholars must possess the ability to genuinely serve their health systems towards achieving health-system goals and sustainable development.

Impact of Segmental Lordosis Restoration During Degenerative Spinal Fusion on Two-Year Adjacent Segment Disease and Revision Rates.

Retrospective cohort study. Assess the impact of inadequate correction of L4-S1 lordosis during transforaminal lumber interbody fusion (TLIF) on adjacent segment disease and revision rates. Restoring alignment is an important consideration in spinal fusions. Failure to correct to level-specific alignment goals could promote the development of adjacent segment disease. As such, it is crucial to investigate the role of sagittal segmental alignment on clinical outcomes following short segment lumbar fusion. Patients who underwent 1- to 3-level transforaminal lumbar interbody fusion (TLIF) and had two-year outcomes data were included in this retrospective cohort study. Segmental lumbar lordosis was assessed in all patients with L3-L4, L4-L5, and L5-S1 constructs. Demographics, radiographic spinopelvic alignment, and complications were compared in a sub-group of patients fused at L4-S1 with adequate (i.e., within 35-45°) and inadequate (i.e., <35°) L4-S1 lordosis. Among the 168 included patients, mean age was 61.7 years, 56.0% were female, and mean follow-up was 32.3 months. Segmental lumbar lordosis did not change significantly after TLIF of L3-L4, L4-L5, or L5-S1 (P>0.05). Two-year postoperatively, 32.7% developed adjacent segment disease and 19.6% underwent revisions. After stratification by adequate (N=15) or inadequate (N=54) restoration of L4-S1 lordosis following initial TLIF surgery, adequately-restored patients had higher preoperative L4-S1 lordosis (Adequately-Restored=39.3° vs Inadequately-Restored=29.5°, P<0.001) and lower two-year postoperative adjacent segment disease (6.7% vs. 33.3%, P=0.032) and revision (5.7% vs. 25.9%, P=0.l33) rates. Adjacent segment disease patients had higher implant-related complications (Adjacent Segment Disease=36.8% vs No Adjacent Segment Disease=8.0%, P=0.008) and subsequent revisions (61.1% vs. 8.7%, P<0.001). Adjacent segment disease and revisions after degenerative lumbar spinal fusion are common. In this cohort, suboptimal restoration of L4-S1 lordosis was associated with higher rates of adjacent segment disease and subsequent revisions, thus highlighting the importance of restoring sagittal alignment in degenerative spine surgery. III.

Playing the Cards You’re Dealt: Implementing Feline Lifesaving Programs and Practices Despite Restrictive Ordinance Provisions

Trap-neuter-return (TNR) programs enjoy strong public support in the U.S. These programs have been shown to successfully increase live release rates and decrease euthanasia rates of cats in animal shelters. However, local laws can impede the implementation of TNR programs. In cooperation with St. Tammany Parish Department of Animal Services, this community case study describes the results of various programs and practices implemented to increase feline lifesaving despite restrictive ordinance provisions, as well as those associated with subsequent ordinance revisions. The St. Tammany Parish Department of Animal Services provided detailed data for the period of January 2015 through December 2023 (e.g. intake, live outcomes, and euthanasia) and information regarding various programs and practices related to feline lifesaving. The data was then examined for general trends. In addition, St. Tammany Parish’s Ordinance No. 21-4618, which includes both the original provisions and revised provisions, was examined for those likely to affect the shelter’s feline admissions and outcomes. The data suggests that the programs and practices implemented were associated with considerable increases in live outcomes for cats (from 26.4 to 95.4%) and corresponding reductions in euthanasia rates (from 71.1 to 3.0%). The adoption of revised ordinance provisions to reduce barriers for community cat management was associated with relatively little change; however, these provisions were generally positive in nature, removing an apparent requirement to impound at-large cats and facilitating the operation of a community cat program (CCP). This community case study illustrates the potential for animal shelters to substantially improve feline lifesaving regardless of possible legal impediments.

Primary Open Reduction and Internal Fixation of Isolated Compound Depressed Nasal Fractures.

The aim of this study was to assess the efficacy of primary open reduction and internal fixation (ORIF) utilizing the existing dorsal wound for the management of isolated nasal fractures characterized by significant depression and to determine its effectiveness in preventing the need for subsequent nasal revisions. A retrospective review was conducted on patients who underwent ORIF of nasal bone for isolated compound depressed nasal fractures from January 2018 to January 2024. The primary outcomes included the assessment of clinical and radiographic results postoperatively, focusing on nasal symmetry, projection, airway patency, and the incidence of secondary surgical interventions. The study included 15 patients, predominantly males (60%), with an average age of 39.33 years. The mechanisms of injury included motor vehicle accidents (40%), falls (26.7%), interpersonal violence (20%), and occupational injuries (13.3%). All patients were treated on the first (73.3%) or second day (26.7%) after the injury. All patients had satisfactory esthetic and functional outcomes and did not require secondary rhinoplasty. The hardware was removed in 4 patients (26.7%). Primary ORIF through an existing dorsal wound for significantly depressed isolated nasal fractures was effective in obviating the necessity for subsequent nasal revisions.

Revision Shoulder Arthroplasty: Predictors of Subsequent Revision Surgery and Economic Burden amongst Medicare Beneficiaries

Revision shoulder arthroplasty continues to add an increasing burden on patients and the healthcare system. This study aimed to delineate long-term shoulder arthroplasty revision incidence, quantify associated Medicare spending, and identify relevant predictors of both revision and spending. The complete 2016-2022(Q3) Medicare fee-for-service inpatient and outpatient claims data was analyzed. Patients receiving a primary total shoulder arthroplasty for osteoarthritis, rotator cuff pathology, or inflammatory arthropathy were included and subsequent ipsilateral revision surgeries were identified. The time to revision was modeled using the Prentice, Williams, and Peterson Gap Time Model. Medicare spending within 90 days post-discharge was modeled using a generalized linear model. The analysis was subdivided by index procedure type: anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). A total of 82,949 primary TSAs and 172,524 RSAs were identified. Compared to index TSA cases, index RSA cases had a lower first revision rate in an observation window of nearly 7 years (1.9% vs. 3.5%, p<0.001), but a higher rate of second (11.4% vs. 4.9%, p<0.001) as well as third revision (13.8% vs. 13.8%, p=0.449). TSA spending was significantly lower than RSA spending for the index procedure ($21,531 vs. $23,267, p<0.001), first ($23,096 vs. $26,414, p<0.001), and second ($25,060 vs. $29,983, p<0.001) revision. There was no statistically significant difference in third revision between TSA and RSA groups ($31,313 vs. $30,829, p=0.860). Age, sex, race, and rheumatoid arthritis were among the top predictors of revisions. Top predictors of Medicare spending included having a non-osteoarthritis surgical indication, a hospital stay of three or more days, a discharge to a setting other than home, malnutrition, dementia, stroke, major kidney diseases, and being operated on in a teaching hospital. Compared with TSA, RSA was associated with a lower first revision rate, but a higher subsequent revision rate. An index RSA procedure was also associated with higher initial Medicare spending as well as subsequent revision surgery spending compared with an index TSA procedure. Demographics and comorbid medical conditions were among the top predictors of revisions, while procedure-related factors predicted Medicare spending.

Complications of intrathecal baclofen therapy in children and young adults

OBJECTIVE The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions. METHODS The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children’s hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling). RESULTS One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p &lt; 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts. CONCLUSIONS Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.

Analysis of nasal fracture management and subsequent surgical outcomes across demographics.

Nasal bone fractures are the most common type of facial injury and can pose significant long-term challenges if not diagnosed and treated correctly at the time of presentation, including, but not limited to, septal hematoma, infection, epistaxis, persistent nasal deformity, nasolacrimal injury, deviated septum, and even mental health issues as serious as post-traumatic stress disorder as persistent complications (1-4). Optimal management remains controversial and subjective based on the clinician's judgment, with many factors playing a role in the provider's decision, including the timing of treatment, the choice between foregoing treatment or choosing to undergo a closed or open reduction, and how to manage subsequent revision surgeries if necessary.

Risk for Revision ACLR After Primary All-Inside Quadrupled Semitendinosus Hamstring Tendon Autograft ACLR With Independent Suture Tape Augmentation: A Retrospective Cohort Study.

The rate of failed anterior cruciate ligament reconstruction (ACLR) remains high in the younger and more active patient populations. Suture tape augmentation (STA) in addition to ACLR may reduce the risk for revision surgery. The purpose of this study was to compare patient outcomes between patients who underwent primary all-inside quadrupled semitendinosus hamstring tendon autograft (QST-HTA) ACLR with and without STA. It was hypothesized that the STA cohort would demonstrate a lower incidence of subsequent revision ACLR while maintaining comparable patient-reported outcomes. Cohort study; Level of evidence, 3. All patients ≤40 years of age who received primary all-inside QST-HTA ACLR with and without independent STA augmentation were identified. The following validated patient-reported outcome measures (PROMs) were collected: visual analog scale for pain, Single Assessment Numeric Evaluation, Knee injury and Osteoarthritis Outcome Score subscales, and Tegner activity scale. KT-1000 arthrometer measurements were collected pre- and postoperatively. Cox proportional hazards model and nominal logistic regression analysis were used to assess additional variables associated with revision ACLR. A total of 104 patients with a mean age of <22 years were included in the final data analysis (STA: 36 patients; control: 68 patients). Significantly fewer patients in the STA group sustained a graft failure necessitating revision surgery at the final follow-up (5.6% vs 24%; relative risk, 0.24 [95% CI, 0.06-0.97]; P = .017). Four-year graft survival was significantly higher in the STA group (97.2% vs 82.4%; P = .031). All PROMs significantly improved postoperatively except for Tegner levels, which decreased in both groups compared with their preinjury levels (P < .001). Return to sports was similar in both groups with >70% of patients returning to their previous level of competition. Regression analysis demonstrated increased risk for revision ACLR in younger patients, high school athletes, and those with higher postoperative activity levels. QST-HTA ACLR with STA was associated with reduced risk for revision ACLR compared with nonaugmented QST-HTA ACLR in this young patient population. Furthermore, the addition of suture tape did not appear to affect postoperative patient-reported and return-to-sports outcomes.

Energy saving starts in the kitchen

The field of sustainable construction and interior design demands innovative solutions to optimize energy efficiency and minimize environmental impact. This need has been further amplified by the European Community's Directive on Energy Efficiency 2012/27/EU and its subsequent revisions. The kitchen, as a central hub of domestic energy use, presents a significant opportunity for improvement. This paper introduces a novel application of heat pump technology for energy reuse in household appliances. The proposed SMACK (SMArt energy-Conserving Kitchen) system embodies a holistic approach, merging eco-sustainability with advanced design principles. SMACK's modularity enables customization and scalability to meet diverse requirements. A comprehensive assessment indicates potential average energy savings approaching 50%, contingent upon appliance configuration. Importantly, this study incorporates preliminary real-world measurements on a minimal appliance, offering empirical insights into the SMACK system's performance. The SMACK project signifies a major step towards environmentally conscious design, setting a new standard for sustainable technology integration within the home.