Time to Conversion of Hemi/total Shoulder Arthroplasty to Reverse Total Shoulder Arthroplasty; A Systematic Review of Longevity and Factors Influencing Conversion

Background: The primary purpose of this study was to determine the average time from hemiarthoplasty (HA) or total shoulder arthroplasty (TSA) to conversion to reverse total shoulder arthroplasty (RTSA). The secondary purpose of this study was to determine the factors leading to conversion to RTSA. Methods: A review of the literature regarding the existing evidence for conversion of HA/TSA to RTSA was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-present), and MEDLINE (1980-present). nclusion criteria were as follows: reporting of conversion of a HA or TSA to RTSA with a follow up of greater than 24 months, English language, and human studies. Excluded were articles that did not mention a time to conversion surgery. Results: One hundred studies were initially retrieved with 3 meeting the inclusion criteria. The review included 99 patients (31 male, 68 female) with a mean age 69 (range: 67 – 73). The average follow up was 35.8 months (range: 32.3 – 37.4). The weighted mean time to conversion of HA/TSA to RTSA was 36.8 months. Rotator cuff failure was the indication for conversion in 19 66% of cases (65/99), while component loosening (glenoid or humeral stem) was the indication in 14% (14/99) of cases. Conclusions: Time to conversion of HA/TSA to RTSA is reported to be 36.8 months on average. The most common indication for conversion to RTSA was rotator cuff failure, suggesting the importance of evaluating pre-operative rotator cuff integrity when performing a primary HA or TSA

Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment (review)

This review investigated whether people with mild cognitive impairment can reduce their risk of developing dementia, or can prevent their memory or other thinking skills from deteriorating further, by taking vitamin or mineral supplements

Prosthetic Joint Infection due to Histoplasma capsulatum in a Patient from Trinidad: Workup, Pathology, and Treatment

Histoplasma capsulatum is a rarely reported cause of prosthetic joint infections. This current case report is of a patient from Trinidad, with a history of a right total knee replacement (TKR), who underwent a successful two-stage revision due to a Histoplasmosis capsulatum periprosthetic joint infection (PJI). This case report offers a unique treatment plan to successfully treat Histoplasmosis capsulatum periprosthetic joint infections and emphasizes the importance of obtaining an accurate travel history

Low frequency mitochondrial DNA heteroplasmy SNPs in blood, retina, and [RPE+choroid] of age-related macular degeneration subjects.

PurposeMitochondrial (mt) DNA damage is associated with age-related macular degeneration (AMD) and other human aging diseases. This study was designed to quantify and characterize mtDNA low-frequency heteroplasmy single nucleotide polymorphisms (SNPs) of three different tissues isolated from AMD subjects using Next Generation Sequencing (NGS) technology.MethodsDNA was extracted from neural retina, [RPE+choroid] and blood from three deceased age-related macular degeneration (AMD) subjects. Entire mitochondrial genomes were analyzed for low-frequency heteroplasmy SNPs using NGS technology that independently sequenced both mtDNA strands. This deep sequencing method (average sequencing depth of 30,000; range 1,000-100,000) can accurately differentiate low-frequency heteroplasmy SNPs from DNA modification artifacts. Twenty-three 'hot-spot' heteroplasmy mtDNA SNPs were analyzed in 222 additional blood samples.ResultsGermline homoplasmy SNPs that defined mtDNA haplogroups were consistent in the three tissues of each subject. Analyses of SNPs with <40% heteroplasmy revealed the blood had significantly greater numbers of heteroplasmy SNPs than retina alone (p≤0.05) or retina+choroid combined (p = 0.008). Twenty-three 'hot-spot' mtDNA heteroplasmy SNPs were present, with three being non-synonymous (amino acid change). Four 'hot-spot' heteroplasmy SNPs (m.1120C>T, m.1284T>C, m.1556C>T, m.7256C>T) were found in additional samples (n = 222). Five heteroplasmy SNPs (m.4104A>G, m.5320C>T, m.5471G>A, m.5474A>G, m.5498A>G) declined with age. Two heteroplasmy SNPs (m.13095T>C, m.13105A>G) increased in AMD compared to Normal samples. In the heteroplasmy SNPs, very few transversion mutations (purine to pyrimidine or vice versa, associated with oxidative damage) were found and the majority were transition changes (purine to purine or pyrimidine to pyrimidine, associated with replication errors).ConclusionWithin an individual, the blood, retina and [RPE+choroid] contained identical homoplasmy SNPs representing inherited germline mtDNA haplogroup. NGS methodology showed significantly more mtDNA heteroplasmy SNPs in blood compared to retina and [RPE+choroid], suggesting the latter tissues have substantial protection. Significantly higher heteroplasmy levels of m.13095T>C and m.13105A>G may represent potential AMD biomarkers. Finally, high levels of transition mutations suggest that accumulation of heteroplasmic SNPs may occur through replication errors rather than oxidative damage

A comparison of clinical and patient-reported outcome measures of TKR: Comparison of Asian to North American patients

Background: Cultural differences between continents may also affect the outcome on interventions. This study compared an Asian and North American cohort of total knee replacement (TKR) patients. Questions/purposes: This study aims to compare the patient-reported outcome measures as well as a functional outcome after TKR between these two different patient populations with a different cultural societal background in two different countries. Patients and Methods: A retrospective study on two cohorts of 76 Asian TKR patients and 64 North American TKR patients were compared. Demographics, patient-reported outcome measures (Knee Society Score (KSS), Patient-Administered Questionnaire (PAQ), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), knee range of motion (RoM), and radiographic component position were compared. Results: The Asian cohort had more females compared to the North American and significantly worse preoperative RoM, and worse KSS function score and PAQ pain scores. The preoperative KSS knee score and WOMAC scores were comparable between the two groups. Postoperatively, the differences in WOMAC and KSS knee scores were significant, while KSS function and PAQ were comparable between groups. Conclusions: Even though Asian TKR patients had significantly worse preoperative scores, their postoperative outcomes were comparable to North Americans. The higher preoperative functional deficit and the higher pain levels in the Asian population might be due to cultural differences and/or socioeconomic reasons, which made Asian patients present with more severe conditions in the preoperative consultation for a possible surgical treatment compared to North Americans. More research is needed to investigate the difference between these cultural impacts on TKR outcomes.Orthopaedics, Trauma Surgery and Rehabilitatio

Clinical Outcomes of a Modern Total Knee Arthroplasty Prosthesis Compared to Its Predecessor at 5-Year Follow-Up: Matched Pair Analysis

Background: Residual pain is an important cause of patient dissatisfaction after total knee arthroplasty (TKA). A recent study at our institution found that a modern prosthesis was associated with less residual and anterior knee pain at 2-year follow-up when compared to its predecessor. The aim of this study is to evaluate these implants at 5-year follow-up. Methods: From July 2012 to December 2013, 100 consecutive modern TKAs were identified from our prospective Institutional Review Board approved database. All patients with 5-year clinical follow-up (n = 77) were matched in a one-to-one fashion based on age, gender, body mass index, and follow-up with a predecessor TKA. Clinical outcomes were assessed with a patient-administered questionnaire for specifically anterior knee pain, painless noise, painful crepitation, and satisfaction. Overall function was assessed using Knee Society Scores and Western Ontario and McMaster University Osteoarthritis Index. Results: At 5-year follow-up, there were no significant differences between the modern TKA and a predecessor TKA in the Knee Society pain or function scores (P =.24 and P =.54, respectively). The overall prevalence of residual pain was less with the modern TKA compared to its predecessor (19.5% vs 36.3%; P =.02), but the prevalence of isolated anterior knee pain was similar in both cohorts (11.7% vs 22.1%; P =.09). There was no difference in painless noise (19.5% vs 13.3%; P =.28) or satisfaction scores (7.9 ± 2.4 vs 7.6 ± 2.6; P =.25) between the modern and predecessor cohorts. Conclusion: At 5-year follow-up, we found that both the modern and predecessor prostheses provided excellent clinical outcomes. The modern TKA was associated with less residual pain compared to its predecessor, but we were unable to detect differences in the prevalence of isolated anterior knee pain, painless noise, Knee Society Scores, or radiographic evaluation

Role of Anatomical Patella Replacement on Anterior Knee Pain

Background Anterior knee pain (AKP) remains a complex issue affecting patient satisfaction after total knee arthroplasty. Several radiographic parameters have been shown to be causative factors with various designs. The aim of this study is to evaluate the known radiographic parameters of AKP and clinical outcomes (ie, AKP) in the setting of a modern prosthesis with an anatomic patella button. Methods Between July 2012 and December 2013, 90 total knee arthroplasties received 3 skyline views taken at 30°, 45°, and 60°. A patient-administered questionnaire was administered at 2-year follow-up to assess the incidence of AKP, painless noise, and satisfaction. Radiographs were analyzed for patellofemoral overstuffing, patellar tilt, and patellar displacement, and evaluated the patella resection angle. Results On the patient-administered questionnaire, 10 (11.1%) patients reported AKP of a mild-to-moderate nature. Thirty-one had the best view at 30 Merchant views, 24 had best views at 45, and 35 had best views at 60. We found that patellar resection angle correlated with AKP (odds ratio 1.21, P = .044) and painless noise (odds ratio 1.22, P = .034). Patellar displacement and patellofemoral stuffing did not correlate with AKP or painless noise. No radiographic measurements correlated with changes in Knee Society Score pain or function scores or range of motion. Conclusion We found that a patellar resection angle correlated with the incidence of AKP and painless noise at 2-year follow-up. We failed to find any correlation with patellofemoral overstuffing, patellar displacement, or patellar tilt with clinical outcomes. We recommend the use of 3 Merchant views to fully evaluate the patellofemoral joint

Low frequency mitochondrial DNA heteroplasmy SNPs in blood, retina, and [RPE+choroid] of age-related macular degeneration subjects.

PurposeMitochondrial (mt) DNA damage is associated with age-related macular degeneration (AMD) and other human aging diseases. This study was designed to quantify and characterize mtDNA low-frequency heteroplasmy single nucleotide polymorphisms (SNPs) of three different tissues isolated from AMD subjects using Next Generation Sequencing (NGS) technology.MethodsDNA was extracted from neural retina, [RPE+choroid] and blood from three deceased age-related macular degeneration (AMD) subjects. Entire mitochondrial genomes were analyzed for low-frequency heteroplasmy SNPs using NGS technology that independently sequenced both mtDNA strands. This deep sequencing method (average sequencing depth of 30,000; range 1,000-100,000) can accurately differentiate low-frequency heteroplasmy SNPs from DNA modification artifacts. Twenty-three 'hot-spot' heteroplasmy mtDNA SNPs were analyzed in 222 additional blood samples.ResultsGermline homoplasmy SNPs that defined mtDNA haplogroups were consistent in the three tissues of each subject. Analyses of SNPs with T, m.1284T>C, m.1556C>T, m.7256C>T) were found in additional samples (n = 222). Five heteroplasmy SNPs (m.4104A>G, m.5320C>T, m.5471G>A, m.5474A>G, m.5498A>G) declined with age. Two heteroplasmy SNPs (m.13095T>C, m.13105A>G) increased in AMD compared to Normal samples. In the heteroplasmy SNPs, very few transversion mutations (purine to pyrimidine or vice versa, associated with oxidative damage) were found and the majority were transition changes (purine to purine or pyrimidine to pyrimidine, associated with replication errors).ConclusionWithin an individual, the blood, retina and [RPE+choroid] contained identical homoplasmy SNPs representing inherited germline mtDNA haplogroup. NGS methodology showed significantly more mtDNA heteroplasmy SNPs in blood compared to retina and [RPE+choroid], suggesting the latter tissues have substantial protection. Significantly higher heteroplasmy levels of m.13095T>C and m.13105A>G may represent potential AMD biomarkers. Finally, high levels of transition mutations suggest that accumulation of heteroplasmic SNPs may occur through replication errors rather than oxidative damage