Midterm Outcomes in Lateral Unicompartment Knee Replacement: The Effect of Patient Age and Bearing Choice.

Isolated lateral compartment knee osteoarthritis (OA) affects between 7 and 10% of patients with knee OA. Although lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment to manage this condition, it is performed relatively infrequently. The aim of this study was to evaluate the mid-term survivorship, radiographic outcomes, and patient-reported outcome measures (PROMs). We performed a retrospective review of a prospectively maintained database of consecutive isolated lateral UKAs performed by a single surgeon at an academic institution between September 2007 and December 2015. Our primary outcome was failure defined as revision surgery to total knee arthroplasty (TKA). Secondary outcomes included any additional surgery for any other reason. Forty-nine consecutive patients (27 females) with median age of 54.7 years (45.2-82.2) met the inclusion criteria. The survival rate for the whole cohort was 86.1% (95% confidence interval [CI]: 73.2-99.0) at 10 years as defined by conversion to TKA. There were a total of four lateral UKAs (all mobile bearings) revised to TKAs. The entire cohort demonstrated statistically significant improvements from preoperative PROMs compared with the most recent postoperative PROMs including the Western Ontario and McMaster Universities Osteoarthritis Index, Knee injury and Osteoarthritis Outcome Score, and Tegner activity scale at a median 8.8 (1.7-12.2) years follow-up. Patients with mobile bearing underwent higher revision to TKA and reoperation for all indications compared with fixed-bearing lateral UKA. In this relatively young cohort, lateral UKA yielded acceptable long-term survival and satisfactory improvement in functional outcomes. Patients who had fixed-bearing implants had similar improvement and trended toward lower revision rates than those with mobile-bearing implants. Level III therapeutic: retrospective Study was performed.

Interscholastic Athletics and Bone Strength: The Iowa Bone Development Study.

ABSTRACT: Pashkova, A, Hartman, JM, Letuchy, EM, and Janz, KF. Interscholastic athletics and bone strength: the Iowa bone development study. J Strength Cond Res 36(5): 1271-1276, 2022-The objective of this study was to determine the relationship between adolescents' participation in various interscholastic sports and differences in bone strength outcomes. Subjects (N = 380) were recruited from the Iowa Bone Development Study and categorized based on sport participation into 3 power groups: no-power, low-power, and high-power. Sports such as basketball, cheerleading/poms, gymnastics, volleyball, track, football, tennis, and soccer were considered high-power. Peripheral quantitative computed tomography (pQCT) was used to determine bone measures of polar stress-strain index (measure of torsion strength), cortical content (measure of cortical bone size and area at the 66% tibia site), and bone strength index (measure of compression strength based on total bone density and area at the 4% tibia site). Adjusted pairwise comparison for group least squares means high-power sport participation compared with no-power sport participation showed significant differences in all bone strength outcomes for both men and women (p value < 0.01). There was a significant difference in all bone strength measures between low-power and no-power groups for men (p value < 0.05), but not women. Because of decreasing levels of physical activity in late adolescence, the promotion of high-power sports may be particularly important for optimal bone development in the final years before peak bone mass.

Influence of physical activity on weight status during the first year of college.

Objective: To provide an analysis of weight change in response to physical activity levels among first year college students. Participants: First year students (N = 114) participated during the 2012-2013 academic year. Methods: Using a web-based survey, researchers gathered information on physical activity and weight at three points: twice throughout the fall and once at the end of the spring semesters. Results: Over half (56.25%) of respondents reported weight gain (between 0.45 and 13.61 kg) from baseline to 9-month follow-up. Weight gainers reported an average gain of 4.20 kg. More than half of participants were not meeting minimal recommendations for cardiorespiratory fitness (59.5%) and strength (53.2%) by the end of the first year of college. Conclusion: This research provides support for intervention and implementation of strategies to promote self-regulation in college students during the transition to college. Addressing the importance of physical activity in weight maintenance is beneficial to first year students' well-being.

Braking Time Following Total Knee Arthroplasty: A Systematic Review.

BACKGROUND: Currently, no guidelines exist to assist surgeons in providing recommendations to patients undergoing total knee arthroplasty (TKA) on when it is safe to return to driving. The purpose of this systematic review is to analyze the best available literature to assist surgeons in providing evidence-based recommendations on when it is safe to return to driving after TKA. METHODS: Following established methodology for the conduct of systematic reviews, a literature search was performed for prospective studies on driving after TKA. Two reviewers screened citations for inclusion, assessed methodological quality, and extracted data. RESULTS: Nine studies with 330 subjects met the inclusion criteria. Normalization of brake response time, movement time, and reaction time to preoperative baseline was assessed by pooling data across studies between 0 and 4 weeks and >4 weeks after TKA. Patients who underwent left TKA and right TKA showed normalization by 2 and 4 weeks, respectively. The limited studies that evaluated brake response time, movement time, and reaction time prior to 2 weeks postoperatively also showed normalization to preoperative levels. CONCLUSION: Patients with right TKA have normalization of braking time by 4 weeks, and normalization is as early as 2 weeks following left TKA. Surgeons must consider these recommendations and other patient factors that determine fitness to drive prior to deeming a patient safe to return to driving.

2015/2016 Quality Risk Management Benchmarking Survey.

This paper investigates the concept of quality risk management (QRM) maturity as it applies to the pharmaceutical and biopharmaceutical industries, using the results and analysis from a QRM benchmarking survey conducted in 2015 and 2016. QRM maturity can be defined as the effectiveness and efficiency of a quality risk management program, moving beyond "check-the-box" compliance with guidelines such as ICH Q9 Quality Risk Management, to explore the value QRM brings to business and quality operations. While significant progress has been made towards full adoption of QRM principles and practices across industry, the full benefits of QRM have not yet been fully realized. The results of the QRM Benchmarking Survey indicate that the pharmaceutical and biopharmaceutical industries are approximately halfway along the journey towards full QRM maturity.LAY ABSTRACT: The management of risks associated with medicinal product quality and patient safety are an important focus for the pharmaceutical and biopharmaceutical industries. These risks are identified, analyzed, and controlled through a defined process called quality risk management (QRM), which seeks to protect the patient from potential quality-related risks. This paper summarizes the outcomes of a comprehensive survey of industry practitioners performed in 2015 and 2016 that aimed to benchmark the level of maturity with regard to the application of QRM. The survey results and subsequent analysis revealed that the pharmaceutical and biopharmaceutical industries have made significant progress in the management of quality risks over the last ten years, and they are roughly halfway towards reaching full maturity of QRM.

Perioperative systemic glucocorticoids in total hip and knee arthroplasty: A systematic review of outcomes.

BACKGROUND: Perioperative systemic glucocorticoids are frequently included in multimodal analgesia and antiemetic regimens administered to patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The objective of this systematic review was to evaluate the available randomized controlled trials (RCTs) to determine the effect of perioperative systemic glucocorticoids on postoperative nausea and vomiting (PONV), pain, narcotic consumption, antiemetic consumption, length of stay in hospital, and major complications in patients undergoing elective THA or TKA. METHODS: A predefined protocol of eligibility and methodology was used for conduct of systematic reviews. Two reviewers screened citations for inclusion, assessed methodological quality, and verified the extracted data. RESULTS: Six RCTs were included for analysis. Across all outcomes analyzed, patients who received glucocorticoids experienced either a benefit or no difference compared to those patients who did not receive glucocorticoids. There were no instances in which perioperative glucocorticoids had a negative impact on any of the outcomes that were analyzed. Furthermore, perioperative glucocorticoids had no effect on the rates of superficial infection, deep infection, wound complications or deep vein thrombosis (DVT). CONCLUSION: The results of this systematic review support the use of perioperative systemic glucocorticoids in patients undergoing elective total hip and knee arthroplasty. Perioperative glucocorticoids have overall positive outcomes with the benefits being more robust in those patients undergoing TKA compared to THA. Glucocorticoids did not increase the occurrence of major complications. There is limited data to support the conclusion that they can reduce length of stay in hospital.

Anatomy and clinical significance of the uncinate process and uncovertebral joint: A comprehensive review.

INTRODUCTION: The uncinate process and its associated uncovertebral articulation are features unique to the cervical spine. This review examines the morphology of these unique structures with particular emphasis on the regional anatomy, development and clinical significance. MATERIALS AND METHODS: Five electronic databases were utilized in the literature search and additional relevant citations were retrieved from the references. A total of 74 citations were included for review. RESULTS: This literature review found that the uncinate processes and uncovertebral articulations are rudimentary at birth and develop and evolve with age. With degeneration they become clinically apparent with compression of related structures; most importantly affecting the spinal nerve root and vertebral artery. The articulations have also been found to precipitate torticollis when edematous and be acutely damaged in severe head and neck injuries. The uncinate processes are also important in providing stability and guiding the motion of the cervical spine. CONCLUSION: This review is intended to re-examine an often overlooked region of the cervical spine as not only an interesting anatomical feature but also a clinically relevant one.

Ecotypic responses of switchgrass to altered precipitation.

Anthropogenic climate change is projected to alter precipitation patterns, resulting in novel environments for plants. The responses of dominant plant species (e.g. Panicum virgatum L. (switchgrass)) to climate changes can drive broader ecosystem processes such as primary productivity. Using a rainfall mesocosm facility, three ecotypes of P. virgatum (collected from Kansas, Oklahoma and Texas, USA) were subjected to three precipitation regimes (average, -25%, +25%) to determine the physiological and growth responses to altered precipitation in a common garden setting. Results showed mean maximum photosynthetic rates, stomatal conductance, transpiration, midday water potential and dark-adapted chlorophyll fluorescence were lowest in the Kansas ecotypes. Increased precipitation treatments raised the mean midday water potentials and lowered water-use efficiency. Aboveground biomass responded positively to changes in precipitation, but flowering initiation was later and rates were lower for Texas ecotypes. In general, ecotype origin was a better predictor of differences in physiological responses and flowering, whereas the precipitation treatments had greater control over biomass production. Depending on the growth variable measured, these results show responses for P. virgatum are under varying ecotypic or environmental control with few interactions, suggesting that future predictions to climate change need not inherently consider localised adaptations in this economically important and widely distributed species.

Self-controlled use of a perceived physical assistance device during a balancing task.

The nature of the relationship between self-controlled conditions and the participant's perception of when and how to use a physical assistance device while practicing a balancing task was examined. Participants in the Self-control group (n= 9) were allowed to decide when to use a balance pole while performing the task, while the Yoked group (n= 9) had no choice regarding pole usage. The Self-control group had immediate performance benefits that persisted on a delayed retention task. Questionnaire results indicated that the Self-control group predominately used the balance pole when attempting a new performance strategy, while the Yoked group reported they would have preferred use of the pole when attempting a new strategy. Results lend support to the assertion that self-controlled conditions facilitate learning because participants can make decisions regarding assistance based on self-generated performance strategy-as relating to their perception of successful movement execution--to a greater extent than under externally controlled conditions.