Is Further Treatment Necessary for Patellar Crepitus After Total Knee Arthroplasty?

Introduction: Posterior-stabilized (PS) TKA that sacrifice the cruciate ligaments improves pain and function in patients with advanced osteoarthritis. Patellar crepitus appears to be due to a spectrum of peripatellar fibrosynovial formations and is usually encountered after PS-TKA, which uniquely has an intercondylar box to accept the tibial post. Symptoms of patellar crepitus occur most commonly during terminal knee extension and occur usually from 3 to 9 months after PS-TKA, and in some cases, this phenomenon is symptomatic enough to warrant an arthroscopic procedure or open arthrotomy. The development of patellar crepitus after PS-TKA appears related to many factors such as femoral component design, surgical errors, increased postoperative knee flexion, and postoperative patellar baja, which are also responsible for patellar clunk syndrome

When is it Safe for Patients to Drive after Right Total Hip Arthroplasty?

Introduction: Driving restrictions after total hip arthroplasty (THA) can be inconvenient and burdensome for patients. When patients may safely be allowed to drive remains controversial. Most studies recommend 6 weeks but recent advances in surgical approach, pain management and rapid recovery may have changed this time frame. The purpose of this study was to prospectively evaluate driving safety after THA through brake reaction time

Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

Introduction: There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied. Methods: Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications. Results: Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly. Discussion: Total hip arthroplasty was found to be an independent risk factor for perioperative complications. Orthopedic surgeons should be aware that the hip fracture population continues to get older, with more medical comorbidities and are at higher risk for perioperative complications. Conclusion: Total hip arthroplasty is associated with a higher rate of perioperative complications in the hip fracture population

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field