ABSTRACT
INTRODUCTION: Tobacco use elevates the incidence of postoperative complications and remains a key modifiable risk factor of perioperative surgical optimization. It remains unclear whether non-tobacco nicotine dependence confers an increased risk of surgical complications. This study evaluates postoperative complications in patients with non-tobacco nicotine dependence for total knee arthroplasty (TKA). METHODS: We queried the TriNetX health database using Current Procedural Terminology and International Classification of Diseases, 10th Revision (ICD-10) codes and identified two cohorts for evaluation. Cohort A was defined as patients who had a TKA; had a dependence on nicotine; did not have nicotine dependence to cigarettes, chewing tobacco, other tobacco products; and were between the ages of 35 and 90 years. Cohort B was defined as patients who had a TKA but did not have a dependence on nicotine or a personal history of nicotine dependence and were between the ages of 35 and 90 years. RESULTS: This study analyzed a total of 10,594 non-tobacco nicotine-dependent patients and 175,079 non-dependent patients who underwent TKA. In the analysis of propensity-matched cohorts, non-tobacco nicotine-dependent patients demonstrated an increased rate of various postoperative complications within 90 days. Dependent patients saw a significantly increased risk of infection after a procedure (P < 0.001), deep vein thrombosis (P < 0.001), pulmonary embolism (P < 0.001), sepsis (P = 0.0065), and prosthetic joint infection (P = 0.0361) and a higher 3-year revision rate (P = 0.0084). DISCUSSION: Non-tobacco nicotine dependence demonstrated an increased associated risk of postoperative surgical complications for patients undergoing TKA. Orthopaedic surgeons should consider evaluating non-tobacco nicotine dependence within their surgical optimization protocol. LEVEL OF EVIDENCE: Level III, Prognostic.
ABSTRACT
There are limited studies in the literature regarding the reconstruction of bilateral anterior cruciate ligament (ACL) injuries in a single-stage setting. However, there have been no published studies describing simultaneous revision reconstructions of previously reconstructed bilateral ACLs. We present the case of a 37-year-old male who underwent previous reconstruction of both ACLs at an outside hospital and presented to our outpatient clinic with instability and pain. Simultaneous bilateral ACL revision reconstruction was performed with the use of tibialis anterior allografts. This case report suggests that single-stage bilateral ACL revision reconstruction is a safe procedure that can provide good results for the patient.
ABSTRACT
A 70-year-old woman was referred to hand surgery after a late failure of ORIF. She subsequently failed a primary total wrist arthroplasty and underwent a revision arthroplasty with a custom implant when her pain and wrist function failed to resolve. The patient reported improved functionality of her left wrist at 2 weeks after revision arthroplasty. At 3 years after surgery, she performed daily activities without pain or difficulty.
ABSTRACT
Surgical training has historically been geared toward right-handed individuals. This could cause mentors to perceive left-handed students and residents as being more difficult to train. This study examined whether differences in dexterity exist between left-handed and right-handed individuals and the implications this may have on surgical training. Recent literature suggests that surgical training may need to be updated to train left-handed students more effectively. In this prospective, crossover study, 50 right-handed and 50 left-handed individuals of varying ages and occupations were evaluated using the O'Conner Tweezer Dexterity Test. Participants were timed while they used flat-tipped forceps to pick up 1â³ brass metal pins and sequentially place one pin each in 100 pinholes 1/16â³ in diameter on a 21â³ × 12â³ board. Participants completed this exercise with their dominant hand followed by their nondominant hand. Nondominant hand dexterity was measured by dividing the nondominant hand completion time by the dominant hand completion time, with a higher percentage associated with higher ambidexterity. Using the Student's two-tailed t test, we found that left-handed individuals had an 97.2% congruence between dominant and nondominant hands while right-handed individuals had a 71.6% congruence (P < 0.001). In conclusion, our results show that left-handed individuals have a greater degree of ambidexterity than their right-handed counterparts. These results suggest that any perceived difference between left-handed and right-handed surgical residents may not be due to innate skill or dexterity, but rather a combination of external influences.
ABSTRACT
Fasciola hepatica is the most widely distributed trematode infection in the world. Control efforts may be hindered by the lack of diagnostic capacity especially in remote endemic areas. Polymerase chain reaction (PCR)-based methods offer high sensitivity and specificity but require expensive technology. However, the recombinase polymerase amplification (RPA) is an efficient isothermal method that eliminates the need for a thermal cycler and has a high deployment potential to resource-limited settings. We report on the characterization of RPA and PCR tests to detect Fasciola infection in clinical stool samples with low egg burdens. The sensitivity of the RPA and PCR were 87% and 66%, respectively. Both tests were 100% specific showing no cross-reactivity with trematode, cestode, or nematode parasites. In addition, RPA and PCR were able to detect 47% and 26% of infections not detected by microscopy, respectively. The RPA adapted to a lateral flow platform was more sensitive than gel-based detection of the reaction products. In conclusion, the Fasciola RPA is a highly sensitive and specific test to diagnose chronic infection using stool samples. The Fasciola RPA lateral flow has the potential for deployment to endemic areas after further characterization.
