Results of a Highly Porous Metal-Backed Cementless Patella Implant: A Minimum 5-Year Follow-Up.

Initial design cementless metal-backed patellar implants failed due to multiple reasons including implant design, use of first-generation polyethylene, and surgical technique. This study evaluates clinical outcomes and survivorship of total knee arthroplasty (TKA) using a current generation highly porous metal-backed patellar component. One-hundred twenty-five consecutive primary cementless TKAs with a compression molded highly porous metal-backed patella were reviewed. One-hundred three TKAs (82.4%) with 5-year clinical and radiographic follow-up were available for review. These were matched with 103 consecutive TKAs using a cemented patella of the same implant design. The cementless cohort had a mean age of 65.5 years, body mass index (BMI) of 33.0, and follow-up of 64.4 months. Indications for cementless TKA were based on multiple factors including age, BMI, and bone quality. There were no revisions for loosening or mechanical failure of the cementless patella compared with two cemented patellae revised for aseptic loosening. Eight patients required revisions in the cementless cohort: three for prosthetic joint infection (PJI), two for instability, one periprosthetic femur fracture, one for patella instability, and one for extensor mechanism rupture. Five patients required revisions in the cemented cohort: two for aseptic patellar loosening, one for aseptic femoral loosening, one for PJI, and one for instability. All-cause survivorship at 5 years was 92.2 and 95.1% for the cementless metal-backed implant and cemented implant cohorts, respectively. Use of a compression molded highly porous metal-backed patella component demonstrated excellent clinical and radiographic results at 5-year follow-up. Longer follow-up is required to evaluate the ability of highly porous cementless patella implants to provide durable long-term fixation.

Not All Proximal Humerus Fractures Do Well Without Surgery: Anterior Translation Predicts the Need for Surgery.

OBJECTIVES: To evaluate the effect of translation on a large series of low-energy proximal humerus fractures initially treated nonoperatively. DESIGN: Retrospective multicenter analysis. SETTING: Five level-one trauma centers. PATIENTS/PARTICIPANTS: Two hundred ten patients (152 F; 58 M), average age 64, with 112 left- and 98 right-sided low-energy proximal humerus fractures (OTA/AO 11-A-C). INTERVENTION: All patients were initially treated nonoperatively and were followed for an average of 231 days. Radiographic translation in the sagittal and coronal planes was measured. Patients with anterior translation were compared with those with posterior or no translation. Patients with ≥80% anterior humeral translation were compared with those with <80% anterior translation, including those with no or posterior translation. MAIN OUTCOMES: The primary outcome was failure of nonoperative treatment resulting in surgery and the secondary outcome was symptomatic malunion. RESULTS: Nine patients (4%) had surgery, 8 for nonunion and 1 for malunion. All 9 patients (100%) had anterior translation. Anterior translation compared with posterior or no sagittal plane translation was associated with failure of nonoperative management requiring surgery ( P = 0.012). In addition, of those with anterior translation, having ≥80% anterior translation compared with <80% was also associated with surgery ( P = 0.001). Finally, 26 patients were diagnosed with symptomatic malunion, of whom translation was anterior in 24 and posterior in 2 ( P = 0.0001). CONCLUSIONS: In a multicenter series of proximal humerus fractures, anterior translation of >80% was associated with failure of nonoperative care resulting in nonunion, symptomatic malunion, and potential surgery. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Manipulation Following Primary Total Knee Arthroplasty is Associated With Increased Rates of Infection and Revision.

BACKGROUND: Stiffness following total knee arthroplasty (TKA) is a disabling complication and manipulation under anesthesia (MUA) is often performed as an early intervention. Few studies have focused on the revision risk, infection risk, demographics, and clinical outcomes in Medicare patients undergoing MUA following primary TKA. METHODS: We reviewed 142,440 patients who had primary TKA from a national database and identified 3,652 patients (2.6%) who underwent MUA. Patient demographics and comorbid conditions were evaluated to identify risk factors. Incidence of revision and periprosthetic joint infection (PJI) at 1-, 2-, and 5-year time points in a cohort of MUA patients was compared to patients who did not undergo MUA. Multivariate Cox regressions were used for statistical analyses. RESULTS: The incidence of MUA was higher in Black versus White individuals (4.1 versus 2.5%, P < .001). Revision risk was significantly greater in the MUA group at 1-, 2-, and 5-year time points with a hazard ratio (HR) of, 3.81, 3.90, and 3.22 respectively, P < .001. One- and 2-year revision risk was significantly greater when MUA occurred at 6 to 12 months post-TKA when compared to <3 months, P < .05. Risk of PJI was significantly greater in the MUA group with a HR of 2.2, 2.2, and 2.1 at 1, 2, and 5 years, respectively P < .001. CONCLUSION: The incidence of MUA was 2.6%. There was an increased incidence of revision surgery and PJI in patients undergoing MUA. Patients at increased risk for stiffness following TKA should be closely monitored and treated with early intervention to minimize risk of poor outcomes.

Rifampin and tobramycin combination with PMMA antibiotic cement.

Rifampin is a powerful antibiotic used in the treatment of biofilm-forming bacteria with studies supporting its use in PMMA cement. However, it has not been widely accepted for its use in PMMA cement due to a perception that it is unable to solidify in a timely manner. The technique described consists of ratio of aminoglycoside and rifampin that reduces time to solidification to approximately 15-20 min.

Comparative Analysis of Bibliometric, Authorship, and Collaboration Trends Over the Past 30-Year Publication History of the Journal of Orthopaedic Trauma and Injury.

OBJECTIVES: In the scientific and medical field, authorship has become increasingly important for tenure and career advancement in addition to improvement in medical care. It was the purpose of this study to investigate changes in bibliometric variables, authorship, and collaboration trends in the Journal of Orthopaedic Trauma (JOT) and Injury over a 30-year period. METHODS: A bibliometric analysis was completed for all manuscripts meeting the inclusion criteria and published throughout 1 representative year of each decade over the past 30 years. A total of 444 and 1105 manuscripts for JOT and Injury, respectively, met the inclusion criteria. Standard statistical analyses were performed with nonparametric methods for continuous variables and Pearson χ and Cochran linear trend tests for categorical variables. A P < 0.05 was considered statistically significant. RESULTS: There were significant increases over time in all bibliometric variables for both journals, except in the number of countries and pages in JOT. For JOT, the overall percentage of female first authors increased 2.3 times from 1987 to 2015 (P = 0.021). The overall percentage of female corresponding authors was 7.3%. For Injury, the overall percentage of female first authors increased 1.5 times (P = 0.007). The overall percentage of female corresponding authors was 13.1%. CONCLUSIONS: Understanding changes in publishing characteristics over time and by region is critical with the rising demands of publishing in academic medicine. JOT and Injury have showed an increase in most variables analyzed. However, female authorship in JOT is climbing at a higher rate than Injury.

MMP14 is a novel target of PTH signaling in osteocytes that controls resorption by regulating soluble RANKL production.

Parathyroid hormone (PTH) affects the skeleton by acting on osteocytes (Ots) in bone through yet unclear mechanisms. We report that matrix metalloproteinase 14 (MMP14) expression/activity are increased in bones from mice with genetic constitutive activation (ca) of the PTH receptor 1 (PTH1R) in Ots (caPTH1ROt) and in bones from mice exposed to elevated PTH levels but not in mice lacking [conditional knockout (cKO)] the PTH1R in Ots (cKOPTH1ROt). Furthermore, PTH upregulates MMP14 in human bone cultures and in Ot-enriched bones from floxed control mice but not from cKOPTH1ROt mice. MMP14 activity increases soluble receptor activator of NF-κΒ ligand production, which in turn, stimulates osteoclast differentiation and resorption. Pharmacologic inhibition of MMP14 activity reduced the high bone remodeling exhibited by caPTH1ROt mice or induced by chronic PTH elevation and decreased bone resorption but allowed full stimulation of bone formation induced by PTH injections, thereby potentiating bone gain. Thus, MMP14 is a new member of the intricate gene network activated in Ots by PTH1R signaling that can be targeted to adjust the skeletal responses to PTH in favor of bone preservation.-Delgado-Calle, J., Hancock, B., Likine, E. F., Sato, A. Y., McAndrews, K., Sanudo, C., Bruzzaniti, A., Riancho, J. A., Tonra, J. R., Bellido, T. MMP14 is a novel target of PTH signaling in osteocytes that controls resorption by regulating soluble RANKL production.

Bibliometric Analysis of Female Authorship Trends and Collaboration Dynamics Over JBMR's 30-Year History.

In academia, authorship is considered a currency and is important for career advancement. As the Journal of Bone and Mineral Research (JBMR) is the highest-ranked journal in the field of bone, muscle, and mineral metabolism and is the official publication of the American Society for Bone and Mineral Research, we sought to examine authorship changes over JBMR's 30-year history. Two bibliometric methods were used to collect the data. The "decade method" included all published manuscripts throughout 1 year in each decade over the past 30 years starting with the inaugural year, yielding 746 manuscripts for analysis. The "random method" examined 10% of published manuscripts from each of the 30 years, yielding 652 manuscripts for analysis. Using both methods, the average number of authors per manuscript, numerical location of the corresponding author, number of collaborating institutions, number of collaborating countries, number of printed manuscript pages, and the number of times each manuscript was cited all significantly increased between 1986 and 2015 (p < 10-4 ). Using the decade method, there was a significant increase in the percentage of female first authors over time from 35.8% in 1986 to 47.7% in 2015 (p = 0.02), and this trend was confirmed using the random method. The highest percentage of female first authors in 2015 was in Europe (60.0%), and Europe also had the most dramatic increase in female first authors over time (more than double in 2015 compared with 1986). Likewise, the overall number of female corresponding authors significantly increased during the past 30 years. With the increasing demands of publishing in academic medicine, understanding changes in publishing characteristics over time and by geographical region is important. These findings highlight JBMR's authorship trends over the past 30 years and demonstrate those countries having the most changes and where challenges still exist. © 2017 American Society for Bone and Mineral Research.