Synthesizing Cubism and Surrealism: Wifredo Lam\u27s 1940s Cuban Works

As a modernist artist, Wifredo Lam used issues of racial degradation and colonialism as a catalyst to create work that directly addressed issues of colonialism in Cuba. Akin to Picasso’s process of appropriating of African motifs within a modern, Cubist style, Wifredo Lam created and appropriated a pastiche of both Surrealistic and Cubist styles into his 1940s paintings. The utilization of these modern styles engendered Lam’s international reputation while providing him with a powerful, creative outlet to express his struggle as an Afro-Cuban. Through the use of African masks and the Santería religion in his paintings during this time period, Lam reappropriated African motifs to their rightful domain within modern art in addition to commenting on racial inequality brought about through colonialism in Cuba. He further berates colonialism through the image of women in his paintings suggesting that colonialism begat European beauty ideologies, sexual exploitation, and the degradation of the African race within Cuba

The John Insall Award: Morbid Obesity Independently Impacts Complications, Mortality, and Resource Use After TKA

BACKGROUND: The importance of morbid obesity as a risk factor for complications after total knee arthroplasty (TKA) continues to be debated. Obesity is rarely an isolated diagnosis and tends to cluster with other comorbidities that may independently lead to increased risk and confound outcomes. It is unknown whether morbid obesity independently affects postoperative complications and resource use after TKA. QUESTIONS/PURPOSES: The purpose of this study was to determine whether morbid obesity is an independent risk factor for inpatient postoperative complications, mortality, and increased resource use in patients undergoing primary TKA. METHODS: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) database was used to identify patients undergoing primary TKA from October 2005 to December 2008. Morbid obesity (body mass index ≥ 40 kg/m(2)) was determined using International Classification of Diseases, 9(th) Revision, Clinical Modification codes. In-hospital postoperative complications, mortality, costs, and disposition for morbidly obese patients were compared with nonobese patients. To control for potential confounders and comorbid conditions, each morbidly obese patient was matched to a nonobese patient using age, sex, and all 28 comorbid-defined elements in the NIS database based on the Elixhauser Comorbidity Index. Of 1,777,068 primary TKAs, 98,410 (5.5%) patients were categorized as morbidly obese. Of these, 90,045 patients (91%) were able to be matched one-to-one to a nonobese patient for the adjusted analysis. RESULTS: Morbidly obese patients had a higher risk of postoperative in-hospital infection (0.24% versus 0.17%; odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1–1.7; p = 0.001), wound dehiscence (0.11% versus 0.08%; OR, 1.3; 95% CI, 1.0–1.7; p = 0.28), and genitourinary-related complications (0.60% versus 0.44%; OR, 1.3; 95% CI, 1.1–1.5; p < 0.001). There was no increase in the prevalence of cardiovascular or thromboembolic-related complications. Morbidly obese patients were at higher risk of in-hospital death after primary TKA compared with nonobese patients (0.08% versus 0.02%; OR, 3.2; 95% CI, 2.0–5.2; p < 0.001). Total hospital costs (USD 15,174 versus USD 14,715, p < 0.001), length of stay (3.6 days versus 3.5 days, p < 0.001), and rate of discharge to a facility (40% versus 30%, p < 0.001) were all higher in morbidly obese patients. CONCLUSIONS: Morbid obesity appears to be independently associated with a higher risk for a small number of select in-hospital postoperative complications and mortality after matching for comorbid medical conditions linked to obesity. However, the independent impact of morbid obesity appears to be fairly modest, and morbid obesity did not appear to be an independent risk factor for many systemic complications. Continued research is necessary to identify the influence of associated comorbidities on early postoperative complications in morbidly obese patients after TKA. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence

Procrastination of Wound Drainage and Malnutrition Affect the Outcome of Joint Arthroplasty

The association between wound drainage and subsequent periprosthetic infection is well known. However, the most appropriate treatment of wound drainage is not well understood. We retrospectively reviewed the records of 10,325 patients (11,785 procedures), among whom 300 patients (2.9%) developed persistent (greater than 48 hours postoperatively) wound drainage. Wound drainage stopped spontaneously between 2 and 4 days in 217 patients treated with local wound care and oral antibiotics. The remaining 83 patients (28%) underwent further surgery. A single débridement resulted in cessation of drainage without subsequent infection in 63 of 83 patients (76%), whereas 20 (24%) patients continued to drain and underwent additional treatment (repeat débridement, resection arthroplasty, or long-term antibiotics). Timing of surgery and the presence of malnutrition predicted failure of the first débridement. There were no differences between the success and failure groups with regard to all other examined parameters, including demographic or surgical factors