Digital Radiography During Total Hip Arthroplasty: Early Results With a Combined Anteversion Technique.

Ideal component positioning is critical to outcomes in total hip arthroplasty. We describe our early results using digital radiographs with a combined ante-version technique. We report the incidence of component adjustments made based on digital radiographs and show how this technology can be used during patient positioning to achieve appropriate starting pelvic alignment. We reviewed 176 cases of primary total hip arthroplasty performed by a single arthroplasty surgeon using a posterior approach. Mean follow-up was 1 year (range, 3 months to 2.7 years). Digital radiographs (Surgeon's Checklist Hip; Radlink) and a combined anteversion technique were used for component positioning. For a subset of 100 patients, we recorded the incidence of pelvic mal-positioning found on digital radiographs obtained during initial positioning of the patient. For this same subset we also detail the component changes made as a result of intraoperative radiographs during trialing. Among 176 cases we have had 2 (1.1%) postoperative dislocations. Both underwent closed reduction with no further dislocation. We have had no revisions and 1 intraoperative calcar fracture. For our 100-case subset, digital radiographs during patient positioning identified pelvic malpositioning greater than 5° (coronal or axial plane) among 17% of cases. During trialing, we made component adjustments 71% of the time because of findings on intraoperative imaging. Digital radiography can be a valuable tool for component positioning during total hip arthroplasty. We experienced favorable early outcomes and show the utility of digital radiographs for proper pelvic positioning and making intraoperative adjustments to achieve optimal component placement. [Orthopedics. 2022;45(4):221-226.].

Oxygen-regulated isoforms of cytochrome c oxidase have differential effects on its nitric oxide production and on hypoxic signaling.

Recently, it has been reported that mitochondria possess a novel pathway for nitric oxide (NO) synthesis. This pathway is induced when cells experience hypoxia, is nitrite (NO(2)(-))-dependent, is independent of NO synthases, and is catalyzed by cytochrome c oxidase (Cco). It has been proposed that this mitochondrially produced NO is a component of hypoxic signaling and the induction of nuclear hypoxic genes. In this study, we examine the NO(2)(-)-dependent NO production in yeast engineered to contain alternative isoforms, Va or Vb, of Cco subunit V. Previous studies have shown that these isoforms have differential effects on oxygen reduction by Cco, and that their genes (COX5a and COX5b, respectively) are inversely regulated by oxygen. Here, we find that the Vb isozyme has a higher turnover rate for NO production than the Va isozyme and that the Vb isozyme produces NO at much higher oxygen concentrations than the Va isozyme. We have also found that the hypoxic genes CYC7 and OLE1 are induced to higher levels in a strain carrying the Vb isozyme than in a strain carrying the Va isozyme. Together, these results demonstrate that the subunit V isoforms have differential effects on NO(2)(-)-dependent NO production by Cco and provide further support for a role of Cco in hypoxic signaling. These findings also suggest a positive feedback mechanism in which mitochondrially produced NO induces expression of COX5b, whose protein product then functions to enhance the ability of Cco to produce NO in hypoxic/anoxic cells.