Multiple coinfections and Guillain Barré syndrome following outdoor travel to the American Northeast.

A 66-year-old immunocompetent man with preceding travel through the Northeastern United States developed Guillain-Barré syndrome. A broad search for infections revealed intraerythrocytic parasites on blood smear and positive polymerase chain reaction for Babesia microti; elevated IgM/IgG serologies for Ehrlichia chaffeensis; elevated IgM/IgG serologies and qualitative polymerase chain reaction for Epstein-Barr virus; and fecal culture growth of Arcobacter butzleri. In this report, we discuss the known or suspected association of these infectious agents with Guillain-Barré syndrome. This case also highlights the importance, in the setting of endemic exposure, of screening for multiple coinfections that can be transmitted by the same arthropod vector.

Liner type has no impact on bone mineral density changes around a 3D printed trabecular titanium acetabular component.

BACKGROUND: Three-dimensional printing of implants allows the ability to produce implants and interfaces which theoretically better mimic "normal" bone behaviour, leading to a possible reduction in stress shielding thus maintaining bone mineral density (BMD). This issue was not investigated in vivo using bone scan and different bearings; therefore, we did a prospective study aiming to answer: 1) is there a loss of BMD around the 3D printed trabecular titanium cup, when compared to the native hip?; 2) does liner type influence the BMD changes around the acetabulum when a 3D printed trabecular titanium cup is used? HYPOTHESIS: BMD changes around the acetabulum are not influenced by the liner type, and the cup will be associated with a reduction in BMD when compared to the native hip. MATERIAL AND METHODS: This is a prospective observational study of patients receiving a primary total hip arthroplasty. A 3D printed trabecular titanium uncemented acetabular component was used in all cases. All patients received a ceramic femoral head, with either a ceramic or polyethylene acetabular liner. BMD measurements using DXA were performed at 6 weeks, 6, 12 and 24 months after surgery to evaluate remodeling changes. The 3 acetabular regions of interest (ROI) of DeLee and Charnley were used for serial comparisons of peri-acetabular BMD. The study was powered as a non-inferiority study with the principle variables compared using a two-step repeated analysis of variance. RESULTS: A total of 48 consecutive patients were included in the study, with all patients completing their 2 year follow-up. There were no failures, revisions or complications within this cohort. We found no statistically significant difference in the BMD change scores between the operated and the native hip in any of the 3 ROI zones. We found no differences in BMD scores when comparing ceramic to polyethylene acetabular liners, head sizes and BMI. DISCUSSION: This study shows a similar pattern of BMD behaviour around a 3D printed cup when compared to the contralateral native hip. We were unable to show a clinical or radiological difference between the bearing material, head size, or BMI when used with this type of acetabular component. LEVEL OF EVIDENCE: III; prospective comparative study.

Fat Embolism Syndrome: The Ambiguity of Diagnosis in the Postarthroplasty Patient: A Case Report.

CASE: We present the case of an otherwise healthy, 74-year-old woman, who underwent bilateral hip arthroplasty and subsequently presented with decreased level of consciousness, mimicking a severe postoperative delirium. After several days and investigations, the diagnosis of fat embolism syndrome (FES) was reached, and appropriate management was given. CONCLUSION: Orthopedic surgeons and their teams should consider FES as a differential diagnosis of prolonged post-operative delirium. With supportive management these patients can make a full recovery without lasting neurological symptoms. Our patient has shown no subsequent sequelae after 10-month follow-up.

Post-operative mortality rates for neck of femur fracture at Waitemata District Health Board.

AIM: Mortality rates of up to 38% at one year have been reported following surgery for neck of femur fractures. The aim of this review is to evaluate the post-operative mortality rates and trends over time for patients with fractured neck of femur at Waitemata District Health Board. METHOD: A retrospective cohort study of all patients who received surgery following a neck of femur fracture at Waitemata District Health Board between 2009 and 2016. Inpatient data was retrieved from electronic hospital records and mortality rates from the Ministry of Health, New Zealand. Analyses included crude mortality rates and trends over time, and time-to-theatre from presentation with neck of femur fracture. RESULTS: A total of 2,822 patients were included in the study; mean age 81.9 years, 70.4% female and 29.6% male. Overall post-operative crude rates for inpatient, 30-day and one-year mortality were 3.7%, 7.2% and 23.8% respectively. Adjusted analyses showed a statistically significant decrease in mortality rates between 2009 and 2016 at inpatient (p=0.001), 30 days (p=<0.001) and one year (p=<0.001) time periods. There was also a significant association between time-to-theatre and mortality at inpatient (p=0.002), 30 days (p=0.0001), and one year (p=0.0002) time periods. CONCLUSION: Mortality rates following surgery for fractured NOF have significantly improved over recent years at Waitemata District Health Board. Reduced time-to-theatre is associated with decreased inpatient, 30-day and one-year mortality.

Medium Term Outcome For A Constrained Acetabular Component At A Single Institution: What Is Important For Success?

BACKGROUND: The use of constrained Total Hip Replacements (THR) is controversial due to lack of definite indications and potentially high failure rates because of mechanical loosening or component failure. A review was performed to assess a departmental use of a single constrained acetabular component over a ten years period. METHODS: Patient demographics, operative indications, complications and patient follow-up were recorded. Post-operative Oxford Hip Scores (OHS) were obtained via a combination of New Zealand Joint Registry interrogation and telephonic questioning. Cup version and inclination angles were obtained from standardised anteroposterior radiographs using established techniques. RESULTS: Forty-four constrained components (in 39 patients) were implanted between 2005 and 2014. The mean age was 78 years with mean ASA 2.7 and mean follow-up 37.2 months (range 13-116). The mean post-operative OHS was 36 (SD 9.25), and there were 4 failures (3 dislocations and 1 peri-prosthetic fracture). The 3 dislocations had either cup ante version (AV) or inclination angles (IA) outside the data set interquartile range (AV 13-24°, IA 40-50°). The cup inclination was significantly lower (p<0.01) in patients with pain on sitting. At post-operative follow-up, 14/39 patients had died from unrelated causes, with only 1 patient surviving beyond 6 years. CONCLUSIONS: Constrained acetabular components offer a solution to hip instability in a difficult group of patients. This study has shown good medium-term outcomes of a single component type in a predominantly frail group of low demand patients. Despite constraint, correct cup placement (particularly inclination) remains important to prevent dislocation or poor reported outcome.

Unicompartmental knee replacement in the elderly: a systematic review.

Unicompartmental knee replacement in the elderly may be associated with a better outcome than total knee replacement. The purpose of this review was to assess the clinical outcome in patients over the age of 70. A computerised search was performed using Pubmed and Embase. Quality assessment was performed using the Newcastle-Ottawa Scale. Eligible studies were identified according to defined criteria and reviewed in terms of peri-operative events, functional outcome and long-term results. 20 studies, representing a minimum of 2956 knees were included. There was a significant increase in the knee society score in the majority of studies to 89.5 (objective) and 80 (function) and the median range of motion (ROM) achieved was 115 degrees. There was no peri-operative mortality and the 10 year prosthesis survival rate was 87.5-98% Revision for periprosthetic infection was low at 0.13-0.30%.

Application of (1)h NMR and multivariate statistics for screening complex mixtures: quality control and authenticity of instant coffee.

Principal components analysis (PCA) followed by linear discriminant analysis (LDA) of the nuclear magnetic resonance (NMR) spectra from 98 instant spray-dried coffees, obtained from 3 different producers, correctly attributed 99% of the samples to their manufacturer. Blind testing of the PCA model with a further 36 samples of instant coffee resulted in a 100% success rate in identifying the samples from the 3 manufacturers. Coffees from one manufacturer were also assigned into 2 groups using these techniques, and the compound 5-(hydroxymethyl)-2-furaldehyde was identified as the primary marker of differentiation.