Predicting Future Sources of Mass Toxic Tort Litigation

The authors describe the efforts of an expert working group to identify potential sources, over the next five to ten years, of future mass litigation and report on the group\u27s consensus conclusions

Giardia lamblia Reactive Arthritis Mimicking Acute Periprosthetic Knee Infection: A Case Report

Background: The difficulty in diagnosing Periprosthetic joint infection (PJI) is exacerbated by the more varied presentation of PJI and the lower synovial fluid WBC count thresholds applied when a prosthesis is present. Multiple reports have described pseudosepsis after total knee arthroplasty (TKA) due to gout or pseudogout. Further confusing the picture, periprosthetic infection also frequently coexists with crystalline arthropathy. Our review of the literature revealed no reports describing reactive arthritis (ReA) mimicking acute infection in the setting of previous TKA. In this case report, we describe a pseudo-periprosthetic infection of a well-functioning TKA secondary to ReA in the setting of Giardia lamblia gastroenteritis. Case: A healthy 49-year-old man with a well-functioning total knee replacement developed a painful swollen knee. The erythrocyte sedimentation rate was 12 mm/hour, and C-reactive protein was 20.3 mg/L. Aspiration revealed 24,440 white blood cells and 5% neutrophils. His 2018 International Consensus Meeting (ICM) definition score of 5 met criteria for “possibly infected.” He was diagnosed with ReA secondary to Giardia lamblia, mimicking acute periprosthetic infection. He was successfully treated with a 10-week course of multiple oral antiparasitic medications. Conclusion: Systemic parasitic infectious ReA can mimic acute infection in the presence of total knee arthroplasty. Careful application of the 2018 ICM criteria can be critical for workup and the treatment of suspected periprosthetic infection

Evaluation of Mercury Exposure Reduction through a Fish Consumption Advisory Program for Anishinaabe Tribal Members in Northern Wisconsin, Michigan, and Minnesota

The Great Lakes Indian Fish and Wildlife Commission has an extensive program to inform Anishinaabe tribal members from northern Wisconsin, Michigan, and Minnesota who harvest and consume walleye about the health risks of consuming these fish, and to encourage harvest and consumption practices that reduce exposure to MeHg. We report here the results of a probabilistic analysis of exposure to methyl mercury (MeHg) among tribal members who consume walleye. The model predicts that the potential for greatest exposures to MeHg occur among women of child-bearing age and children who consume large walleye from lakes that contain heavily contaminated (MeHg concentration >0.5 mg/kg) fish. The analysis allows GLIFWC to evaluate, focus, and fine-tune its initiatives to protect the health of tribal members in ways that result in exposure and risk reduction for tribal harvesters, women of child-bearing age, and children, while maintaining important tribal lifeways, which include the harvest and consumption of walleye

Recurrent Hemarthrosis Secondary to Erosive Patellofemoral Arthritis Treated with Arthroplasty: A Report of 3 Cases

Background: Spontaneous hemarthrosis of the knee joint in the elderly population is a rare phenomenon and is mostly seen in those with osteoarthritis. The identified causes of spontaneous hemarthrosis in this demographic include subchondral bone bleeding, meniscal tear, genicular artery bleeding, and the use of anticoagulants. Hemarthrosis caused by isolated patellofemoral bleeding, as in this case series, has been rarely documented and poorly described. Case: Three patients presented with recurrent hemarthrosis secondary to erosive patellofemoral arthritis. Recurrent hemarthrosis from the eroded patellofemoral subchondral bone has not been well described. Each patient presented with symptoms secondary to painful effusions that were identified by aspiration. Each patient was successfully treated with patellofemoral or total knee arthroplasty Conclusion: Spontaneous or recurrent effusions in the setting of erosivepatellofemoral arthritis should prompt orthopaedic surgeons to consider hemarthrosis as the cause of such effusions. Patellofemoral or total knee arthroplasty is effective in resolving the hemarthroses, resolving pain, and restoring function in these patients