Surgical approach in primary total hip arthroplasty: Anatomy, technique and clinical outcomes

©2015 8872147 Canada Inc. Total hip arthroplasty (THA) has revolutionized the treatment of hip arthritis. A number of surgical approaches to the hip joint exist, each with unique advantages and disadvantages. The most commonly used approaches include the direct anterior, direct lateral and posterior approaches. A number of technical intricacies allow safe and efficient femoral and acetabular reconstruction when using each approach. Hip dislocation, abductor insufficiency, fracture and nerve injury are complications of THA, although their relative risk varies by approach. Numerous clinical trials have sought to elicit differences in patient-reported outcomes, complication rates and return to function among the surgical approaches. This review outlines some of the technical pearls of performing a THA through either a direct anterior, direct lateral or posterior approach. A literature review outlines the impact of surgical approach on clinical outcomes and clinically relevant complication rates

Virtual Auditing Agents: The EDGAR Agent Challenge

Intelligent agents can be used as agents of organizational change. This potential exists in the domain of accounting audit, where much of what is currently done manually in batch mode could be done continuously and on-line. We discuss the use of intelligent Internet agents as a way of changing and expanding audit practices in the virtual world. A quality/service framework is presented that suggests ways that accounting firms can evolve in this era of on-line opportunities. The EDGAR Agent is presented as an example of an intelligent Internet agent that gathers financial information. The challenges involved in the development of the EDGAR agent are analyzed, providing insight into the practical aspects of agent technology designed for a specific business domain. A test of the agent is presented, with comments and suggestions from financial practitioners that will be integrated into the research stream

Assuring Homeland Security: Continuous Monitoring, Control and Assurance of Emergency Preparedness

This paper examines the potential relationships of Continuous Auditing and Emergency Preparedness to the design, development, and implementation of Emergency Response Management Information Systems (ERMIS). It develops an argument for the integration of emergency response processes and continuous decision process auditing requirements into the system development life cycle of an organization wide ERMIS

The economic impact of periprosthetic infection in total hip arthroplasty

© 2020 Canadian Medical Association. All rights reserved. Background: Periprosthetic joint infection (PJI) is the third leading cause of total hip arthroplasty (THA) failure. Although controversial, 2-stage revision remains the gold standard treatment for PJI in most situations. To date, there have been few studies describing the economic impact of PJI in today\u27s health care environment. The purpose of the current study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in THA and to assess the economic burden of PJI compared with primary uncomplicated THA. Methods: We conducted a review of primary THA cases and 2-stage revision THA for PJI at our institution. Patients were matched for age and body mass index. All costs associated with each procedure were recorded. Descriptive statistics were used to summarize the collected data. Mean costs, length of stay, clinic visits and readmission rates associated with the 2 cohorts were compared. Results: Fifty consecutive cases of revision THA were matched with 50 cases of uncomplicated primary THA between 2006 and 2014. Compared with the primary THA cohort, PJI was associated with a significant increase in mean length of hospital stay (26.5 v. 2.0 d, p \u3c 0.001), mean number of clinic visits (9.2 v. 3.8, p \u3c 0.001), number of readmissions (12 v. 1, p \u3c 0.001) and average overall cost (Can$38 107 v. Can$6764, t = 8.3, p \u3c 0.001). Conclusion: Treatment of PJI is a tremendous economic burden. Our data suggest a 5-fold increase in hospital expenditure in the management of PJI compared with primary uncomplicated THA

Use of the Corail stem for revision total hip arthroplasty: Evaluation of clinical outcomes and cost

© 2019 Joule Inc. or its licensors. Background: With the growing number of total hip arthroplasty (THA) procedures performed, revision surgery is also proportionately increasing, resulting in greater health care expenditures. The purpose of this study was to assess clinical outcomes and cost when using a collared, fully hydroxyapatite-coated primary femoral stem for revision THA compared to commonly used revision femoral stems. Methods: We retrospectively identifed patients who underwent revision THA with a primary stem between 2011 and 2016 and matched them on demographic variables and reason for revision to a similar cohort who underwent revision THA. We extracted operative data and information on in-hospital resource use from the patients\u27 charts to calculate average cost per procedure. Patient-reported outcomes were recorded preoperatively and 1 year postoperatively. Results: We included 20 patients in our analysis, of whom 10 received a primary stem and 10, a typical revision stem. There were no signifcant between-group differences in mean Western Ontario and McMaster Universities Osteoarthritis Index score, Harris Hip Score, 12-Item Short Form Health Survey (SF-12) Mental Composite Scale score or Physical Composite Scale score at 1 year. Operative time was signifcantly shorter and total cost was signifcantly lower (mean difference -3707.64, 95% confdence interval -5532.85 to -1882.43) with a primary stem than with other revision femoral stems. Conclusion: We found similar clinical outcomes and signifcant institutional cost savings with a primary femoral stem in revision THA. This suggests a role for a primary femoral stem such as a collared, fully hydroxyapatite-coated stem for revision THA

Effect of the extent of release for knee balancing on post-operative limb coronal alignment after primary total knee arthroplasty

© 2020 Alzahrani et al. Introduction: Outcomes and longevity of total knee arthroplasty (TKA) depend mainly on restoring knee function, through precise bony resection and appropriate soft tissue balancing. The current literature lacks evidence regarding the degree of radiographic change after intra-operative knee balancing. The purpose of our study was to assess the degree of change in coronal lower extremity alignment by comparing pre-operative to post-operative full-length radiographs (FLR) after quantifying the degree of intra-operative knee balancing and corre-late patient-reported outcomes to the extent of balancing required. Patients and Methods: One hundred and fifty-four patients undergoing primary TKA for varus knee osteoarthritis were included in the study. The performed soft tissue releases and bony adjustments to obtain a balanced TKA intra-operatively were prospectively documen-ted and were grouped into minimal, moderate and extensive release groups. Hip-knee-ankle angle (HKA), anatomical femoral-tibial angle (FTA), condylar hip angle (CH), medial proximal tibial angle (MPTA) and condylar plateau angle (CPA) were measured on full-length radiographs both pre-operatively and post-operatively. Frequencies of the soft tissue releases and bony resections in addition to descriptive statistics of the measured angles on the radiographs were recorded. In addition, patient-reported outcome scores (PROMs) were compared between the grouped patients. Results: Of those that were included in the study, 66 knees (42.9%) required minimal release to adequately balance the knee, while 70 (45.5%) required moderate release and 18 (11.7%) required extensive release. No statistically significant differences were found in change of alignment between the groups for all the measured angles. In addition, no difference in PROMs was seen between the groups both pre-and post-operatively. Conclusion: Although we found no association between post-operative coronal alignment of a TKA and the degree of soft tissue release and bony resection, this likely represents the fact that a balanced TKA is dynamic and not dependent on change of single radiographic parameters. Patient-reported outcomes were not impacted by the extent of releases

Design and Applications of an Intelligent Financial Reporting and Auditing Agent with Net Knowledge (FRAANK)

This paper discusses the use of intelligent Internet agents as essential tools for automating financial analysis functions in the virtual world. Several important characteristic features of intelligent agents are discussed, including autonomy, communication ability, collaboration, and mobility. This paper focuses on developing a new intelligent agent called FRAANK – Financial Reporting and Auditing Agent with Net Knowledge. The prototype of FRAANK described in this paper provides intelligent access to, and processing and integration of rapidly changing financial information available from various sources on the Internet. FRAANK is an example of an agent that provides a value-added service that can be used for extracting data from natural text financial statements and converting them into XBRL-tagged statements, can potentially be utilized in an auditing practice, or used by investors and creditors in making their decisions

Virtual auditing agents: The edgar agent challenge

Intelligent agents can be used as agents of organizational change. This potential exists in the domain of accounting audit, where much of what is currently done manually in batch mode could be done continuously and on-line. We discuss the use of intelligent Internet agents as a way of changing and expanding audit practices in the virtual world. A quality/service framework is presented that suggests ways that accounting firms can evolve in this era of on-line opportunities. The EDGAR Agent is presented as an example of an intelligent Internet agent that gathers financial information. The challenges involved in the development of the EDGAR agent are analyzed, providing insight into the practical aspects of agent technology designed for a specific business domain. A test of the agent is presented, with comments and suggestions from financial practitioners that will be integrated into the research stream

How are nitrogen availability, fine-root mass, and nitrogen uptake related empirically? Implications for models and theory

We gratefully acknowledge funding from Loyola University Chicago; suggestions for improvement by David Robinson and anonymous peer reviewers; logistical support from K. Erickson; help with maintenance and harvests from O. Urbanski, L. Papaioannou, H. Roudebush, & V. Roudebush; and tissue and substrate analyses from Z. Zhu. The authors have no conflicts of interest to report.Peer reviewedPostprin