Reevaluating isolated polyethylene revision for instability after total knee arthroplasty.

BACKGROUND: Instability is a common mode of failure after primary total knee arthroplasty (TKA). Surgical management includes total revision and isolated polyethylene exchange. This study aimed to evaluate outcomes after isolated polyethylene exchange for instability in one of the largest cohorts reported to date. METHODS: This is a retrospective study of 87 patients and 93 cases of isolated polyethylene exchange after TKA for instability at a tertiary academic center. Preoperative and postoperative Knee Society Scores were compared using paired T-testing with a significance level set at p = .05. Secondary outcomes included satisfaction, complications, rates of additional surgery, and recurrent instability. RESULTS: Of the 87 patients, 61 patients had both pre and post-operative KSS-Knee scores and 60 with matched KSS-Functional scores. KSS-Knee scores significantly increased from 63.78 to 83.13 (p < .05), and KSS-Functional scores increased from 63.80 to 84.00 (p < .05). Seven of 93 cases (7.78%) cases required additional surgery at an average of 3.8 years, including two for recurrent instability. Nine (10%) cases were initially satisfied but developed recurrent instability at an average of 27.6 months. CONCLUSION: Isolated polyethylene exchange after TKA for instability resulted in significantly increased reported clinical outcome scores. Isolated polyethylene exchange after TKA for recurrent instability may be a viable option but surgeons should consider the rate of complications requiring surgery as well as high rate of recurrent instability. More studies with longer-term follow-up are required to further identify which patients may benefit the most from isolated polyethylene exchange after TKA for recurrent instability.

Recurrent Failures After 2-Stage Exchanges are Secondary to New Organisms Not Previously Covered by Antibiotics.

Background: Prior studies have shown that the majority of re-infections following two-stage revisions are due to organisms different from the initial organisms identified. It remains unknown whether these new organisms were susceptible to the antibiotics given (indicating the patient likely developed another infection following successful treatment) or not susceptible (indicating these organisms may have been initially present, but were not identified, and thus, inadequately treated). The purpose of this study was to determine if bacteria identified at time of re-infection following two-stage revisions were susceptible to the antibiotics administered during treatment of the index infection, in order to understand if these are new infections or from organisms that were present but not initially identified. Methods: Thirty failures (19 knees and 11 hips) following two-stage revisions from four institutions were identified. Cultures and antibiotic sensitivities were used to determine whether the re-infectious organisms were new and if they were susceptible to the antibiotics initially given. Results: Twenty-five (83.3%) re-infections were due to new organisms. Of these re-infections from new organisms, 16 (64.0%) were susceptible to the antibiotics previously administered, suggesting they were new infections rather than persistent infections from organisms that were not detected during initial treatment. No statistically significant differences in demographics or time to revision were observed when comparing by organism type (new vs. repeat) or by antibiotic susceptibility. Conclusions: Failures following two-stage revisions are frequently due to organisms different than those identified prior to two-stage revision and are likely new infections rather than persistent infections from undetected organisms.

Demographic and occupational predictors of neck pain in pilots: analysis and multinational comparison.

OBJECTIVE: This study aimed to elucidate the overall risk and demographic/occupational predictors of neck pain among professional aviators. METHODS: There were 413 surveys characterizing the severity and character of neck pain symptoms that were administered to a multinational cohort of pilots representing 3 separate airframe types. All results were compared to a nonaviator control group. Univariate and multivariate regression analyses were performed to elucidate independent predictors of occupationally related neck pain. RESULTS: Of the surveys, 92% were completed and returned. Multivariate analysis reveals that the pilot profession is independently predictive of increased occupational neck pain symptoms (OR 1.94, 95% CI 3.72, 1.01). High performance airframes, cargo/passenger airframes, and increasing age were also independent predictors of increased neck pain scores (OR = 3.91, 95% CI 7.10, 2.15; OR = 3.22, 95% CI 5.83, 1.77; OR = 4.00, 95% CI 7.43, 2.15, respectively). CONCLUSIONS: Our broad, multinational/multi-airframe analysis reveals that the pilot profession, most notably high performance and long-haul cargo/passenger airframes, display an increased risk of neck pain symptoms.

Nursing home revenue source and information availability during the emergency department evaluation of nursing home residents.

OBJECTIVES: Lack of access to medical information for nursing home residents during emergency department (ED) evaluation is a barrier to quality care. We hypothesized that the quantity of information available in the ED differs based on the funding source of the resident's nursing home. DESIGN: Cross-sectional observational study. SETTING: Single academic ED. PARTICIPANTS: Participants were 128 skilled nursing facility (SNF) residents age 65 or older from 12 SNFs. MEASUREMENTS: Emergency physicians documented knowledge of 9 essential information items. SNFs were categorized as accepting or not accepting Medicaid. RESULTS: Questionnaires were completed for 128 patients, of whom 95 (74%) were from 1 of 8 Medicaid-funded SNFs and 33 (26%) were from 1 of 4 SNFs not accepting Medicaid. Patients from SNFs accepting Medicaid were younger (79 versus 87, P < .001) and less frequently white (62% versus 97%, P < .001). The mean number of 9 possible information items available was lower for patients from SNFs that accept Medicaid (7.13 versus 8.15, P < .001). Emergency providers also reported lower satisfaction regarding access to information for residents from SNFs that accept Medicaid (P < .05). The association between residence in an SNF that accepts Medicaid and lower ED information scores remained after linear regression with clustering by SNF controlling for age, gender, and race. The most common source of information for residents from both types of SNFs was transfer papers from the SNF. CONCLUSION: Less information is available to ED providers for patients from SNFs that accept Medicaid than for residents from SNFs that do not accept Medicaid. Further study is needed to examine this information gap.