Conventional versus highly cross-linked polyethylene in primary total knee replacement : a comparison of revision rates using data from the National Joint Registry for England, Wales, and Northern Ireland

There is evidence to support the use of highly cross-linked polyethylene (HXLPE) in patients undergoing total hip arthroplasty. However, the benefits for those undergoing total knee arthroplasty are uncertain, with conflicting reports based on previous cohort analyses. The purpose of the present study was to compare the revision rates following primary total knee arthroplasty with use of HXLPE as compared with conventional polyethylene (CPE) using data from the National Joint Registry (NJR) for England, Wales and Northern Ireland. We performed a retrospective analysis of primary total knee arthroplasties recorded in the NJR from 2003 to 2014. Cobalt-chromium (CoCr)-CPE and CoCr-HXLPE bearing surfaces were compared using all-cause revision, aseptic revision, and septic revision as end points. Survival analyses were conducted using rates per 100 years observed, Kaplan-Meier survival estimates, and Cox regression hazard ratios (HRs) adjusted for age, sex, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), lead surgeon grade, and implant constraint. Secondary analyses compared the most commonly used HXLPEs (Zimmer Prolong, DePuy XLK, and Stryker X3) against CPE for the 3 most common total knee arthroplasty systems (NexGen, PFC Sigma, and Triathlon). In the present study of 550,658 total knee arthroplasties, the unadjusted aseptic revision rates were significantly lower following procedures performed with CPE (n = 513,744) as compared with those performed with HXLPE total knee replacements (n = 36,914) (0.29 [95% confidence interval (CI), 0.28 to 0.30] compared to 0.38 [95% CI, 0.35 to 0.42], p 35 kg/m, the "second-generation" Stryker X3 HXLPE demonstrated significantly better survival than its respective CPE, with CPE having an HR of 2.6 (95% CI, 1.2 to 5.9) (p = 0.02). Alternative bearings are marketed as having improved wear properties over traditional CoCr-CPE. This registry-based analysis demonstrated no overall survival benefit of HXLPE after a maximum duration of follow-up of 12 years. Because of their increased cost, the routine use of HXLPE bearings may not be justified. However, they may have a role in specific "higher demand" groups such as patients 35 kg/m. Therapeutic Level III. See Instructions for Authors for a complete list of levels of evidence

Photometry Using Kepler ”superstamps” of Open Clusters NGC 6791 & NGC 6819

The Kepler space telescope has proven to be a gold mine for the study of variable stars. Usually, Kepler only reads out a handful of pixels around each pre-selected target star, omitting a large number of stars in the Kepler field. Fortunately, for the open clusters NGC 6791 and NGC 6819, Kepler also read out larger superstamps which contained complete images of the central region of each cluster. These cluster images can be used to study additional stars in the open clusters that were not originally on Kepler\u27s target list. We discuss our work on using two photometric techniques to analyze these superstamps and present sample results from this project to demonstrate the value of this technique for a wide variety of variable stars

Constraining the degree of the dominant mode in QQ Vir

We present early results of the application of a method which uses multicolor photometry and spectroscopy for \ell discrimination. This method has been successfully applied to the pulsating hot subdwarf Balloon 090100001. Here we apply the method to QQ Vir (PG1325+101). This star was observed spectroscopically and photometrically in 2008. Details on spectroscopy can be found in Telting et al. (2010) while photometry and preliminary results on \ell discrimination are provided here. The main aim of this work was to compare the value of the \ell parameter derived for the main mode in QQ Vir to previously published values derived by using different methods.Comment: Proceedings of The Fourth Meeting on Hot Subdwarf Stars and Related Objects held in China, 20-24 July 2009. Accepted for publication in Astrophysics and Space Scienc

The sdB pulsating star V391 Peg and its putative giant planet revisited after 13 years of time-series photometric data

V391 Peg (alias HS 2201+2610) is a subdwarf B (sdB) pulsating star that shows both p- and g-modes. By studying the arrival times of the p-mode maxima and minima through the O-C method, in a previous article the presence of a planet was inferred with an orbital period of 3.2 years and a minimum mass of 3.2 MJup. Here we present an updated O-C analysis using a larger data set of 1066 h of photometric time series ( 2.5× larger in terms of the number of data points), which covers the period between 1999 and 2012 (compared with 1999-2006 of the previous analysis). Up to the end of 2008, the new O-C diagram of the main pulsation frequency (f1) is compatible with (and improves) the previous two-component solution representing the long-term variation of the pulsation period (parabolic component) and the giant planet (sine wave component). Since 2009, the O-C trend of f1 changes, and the time derivative of the pulsation period (p.) passes from positive to negative; the reason of this change of regime is not clear and could be related to nonlinear interactions between different pulsation modes. With the new data, the O-C diagram of the secondary pulsation frequency (f2) continues to show two components (parabola and sine wave), like in the previous analysis. Various solutions are proposed to fit the O-C diagrams of f1 and f2, but in all of them, the sinusoidal components of f1 and f2 differ or at least agree less well than before. The nice agreement found previously was a coincidence due to various small effects that are carefully analyzed. Now, with a larger dataset, the presence of a planet is more uncertain and would require confirmation with an independent method. The new data allow us to improve the measurement of p. for f1 and f2: using only the data up to the end of 2008, we obtain p.1 = (1.34 ± 0.04) × 10-12 and p.2 = (1.62 ± 0.22) × 10-12. The long-term variation of the two main pulsation periods (and the change of sign of p.1) is visible also in direct measurements made over several years. The absence of peaks near f1 in the Fourier transform and the secondary peak close to f2 confirm a previous identification as l = 0 and l = 1, respectively, and suggest a stellar rotation period of about 40 days. The new data allow constraining the main g-mode pulsation periods of the star

The effect of high dose antibiotic impregnated cement on rate of surgical site infection after hip hemiarthroplasty for fractured neck of femur : a protocol for a double-blind quasi randomised controlled trial

Background: Mortality following hip hemiarthroplasty is in the range of 10-40% in the first year, with much attributed to post-operative complications. One such complication is surgical site infection (SSI), which at the start of this trial affected 4.68% of patients in the UK having this operation. Compared to SSI rates of elective hip surgery, at less than 1%, this figure is elevated. The aim of this quasi randomised controlled trial (RCT) is to determine if high dose antibiotic impregnated cement can reduce the SSI in patients at 12-months after hemiarthroplasty for intracapsular fractured neck of femur. Methods: 848 patients with an intracapsular fractured neck of femur requiring a hip hemiarthroplasty are been recruited into this two-centre double-blind quasi RCT. Participants were recruited before surgery and quasi randomised to standard care or intervention group. Participants, statistician and outcome assessors were blind to treatment allocation throughout the study. The intervention consisted of high dose antibiotic impregnated cement consisting of 1 gram Clindamycin and 1 gram of Gentamicin. The primary outcome is Health Protection Agency (HPA) defined deep surgical site infection at 12 months. Secondary outcomes include HPA defined superficial surgical site infection at 30 days, 30 and 90-day mortality, length of hospital stay, critical care stay, and complications. Discussion: Large randomised controlled trials assessing the effectiveness of a surgical intervention are uncommon, particularly in the speciality of orthopaedics. The results from this trial will inform evidence-based recommendations for antibiotic impregnated cement in the management of patients with a fractured neck of femur undergoing a hip hemiarthroplasty. If high dose antibiotic impregnated cement is found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip hemiarthroplasty

Clinical Study Local Anaesthetic Infiltration and Indwelling Postoperative Wound Catheters for Patients with Hip Fracture Reduce Death Rates and Length of Stay

Background. An analgesic enhanced recovery (ER) protocol for patients with a hip fracture was introduced. It was hypothesised that the ER would reduce pain, length of stay and improve clinical outcomes. The protocol used intraoperative infiltration of levobupivacaine followed by ongoing wound infusions. Methods. Consecutive patients admitted to two hospitals were eligible for the ER protocol. Numerical Reporting Scale pain scores (0-10) were recorded alongside opiate requirements. 434 patients in the ER group (316 full ER, 90 partial ER, and 28 no ER) were compared to a control group (CG) of 100 consecutive patients managed with traditional opiate analgesia. Results. Mean opiate requirement was 49.2 mg (CG) versus 32.5 mg (ER). Pain scores were significantly reduced in the full ER group, < 0.0001. Direct discharge home and mean acute inpatient stay were significantly reduced ( = 0.0031 and < 0.0001, resp.). 30-day mortality was 15% (CG) versus 5.5% (ER), = 0.0024. Conclusions. This analgesic ER protocol for patients with a hip fracture was safe and effective and was associated with reduced inpatient stay and mortality

Emerging Infectious Disease leads to Rapid Population Decline of Common British Birds

Emerging infectious diseases are increasingly cited as threats to wildlife, livestock and humans alike. They can threaten geographically isolated or critically endangered wildlife populations; however, relatively few studies have clearly demonstrated the extent to which emerging diseases can impact populations of common wildlife species. Here, we report the impact of an emerging protozoal disease on British populations of greenfinch Carduelis chloris and chaffinch Fringilla coelebs, two of the most common birds in Britain. Morphological and molecular analyses showed this to be due to Trichomonas gallinae. Trichomonosis emerged as a novel fatal disease of finches in Britain in 2005 and rapidly became epidemic within greenfinch, and to a lesser extent chaffinch, populations in 2006. By 2007, breeding populations of greenfinches and chaffinches in the geographic region of highest disease incidence had decreased by 35% and 21% respectively, representing mortality in excess of half a million birds. In contrast, declines were less pronounced or absent in these species in regions where the disease was found in intermediate or low incidence. Also, populations of dunnock Prunella modularis, which similarly feeds in gardens, but in which T. gallinae was rarely recorded, did not decline. This is the first trichomonosis epidemic reported in the scientific literature to negatively impact populations of free-ranging non-columbiform species, and such levels of mortality and decline due to an emerging infectious disease are unprecedented in British wild bird populations. This disease emergence event demonstrates the potential for a protozoan parasite to jump avian host taxonomic groups with dramatic effect over a short time period