Benchmarking total knee replacement constructs using noninferiority analysis:the New Zealand Joint Registry study

Abstract Background The aim of this study was to compare the relative performance of total knee replacement constructs and discern if there is variability in performance in currently commonly used prostheses in the New Zealand Joint Registry (NZJR) using a noninferiority analysis. Methods All patients who underwent a primary total knee replacement (TKR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of total knee replacement prostheses were compared with the best performing contemporary construct. Construct all-cause revision rate was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in all-cause revision rates between the contemporary benchmark and all other constructs was tested. Results In total 110 183 TKR were recorded and 25 constructs (102 717 procedures) had > 500 procedures at risk at 3 years post-primary of which 5 were inferior by at least 20 % relative risk of which, one was inferior by at least 100 % relative risk. 14 constructs were identified with > 500 procedures at risk at 10 years with 5 inferior by at least 20 %, of which 2 were inferior by > 100 % relative risk. Conclusions We discerned that there is great variability in construct performance and at all time points, greater than 25 % of constructs are inferior to the best performing construct by at least 20 %. These results can help inform patients, clinicians and health care funders when considering TKR surgery

Benchmarking total hip replacement constructs using noninferiority analysis:the New Zealand joint registry study

Abstract Background The aim of this study was to compare the relative performance of total hip replacement constructs and discern if there is substantial variability in performance in currently commonly used prostheses in the New Zealand Joint Registry (NZJR) using a noninferiority analysis. Methods All patients who underwent a primary total hip replacement (THR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of hip prostheses were compared with the best performing contemporary construct. Construct failure was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in failure between the contemporary benchmark and other constructs was examined. Results In total 135,432 THR were recorded comprising 1035 different THR constructs. Notably 328 constructs were used just once. Forty-eight constructs (62,251 THR) had > 500 procedures at risk at 3 years post-primary of which 28 were inferior by at least 20% relative risk of which, 10 were inferior by at least 100% relative risk. Sixteen constructs were identified with > 500 procedures at risk at 10 years with 9 inferior by at least 20%, of which one was inferior by > 100% relative risk. There were fewer constructs noninferior to the best practice benchmark when we performed analysis by gender. In females at 10 years, from 5 constructs with > 500 constructs at risk, 2 were inferior at the 20% margin. In males at 10 years, there were only 2 eligible constructs of which one was inferior at the 20% margin. Conclusions We discerned that there is substantial variability in construct performance and at most time points, just over half of constructs are inferior to the best performing construct by at least 20%. These results can facilitate informed decision-making when considering THR surgery

Extinction and the Dimming of KIC 8462852

To test alternative hypotheses for the behavior of KIC 8462852, we obtained measurements of the star over a wide wavelength range from the UV to the mid-infrared from October 2015 through December 2016, using Swift, Spitzer and at AstroLAB IRIS. The star faded in a manner similar to the long-term fading seen in Kepler data about 1400 days previously. The dimming rate for the entire period reported is 22.1 +\- 9.7 milli-mag/yr in the Swift wavebands, with amounts of 21.0 +\- 4.5 mmag in the groundbased B measurements, 14.0 +\- 4.5 mmag in V, and 13.0 +\- 4.5 in R, and a rate of 5.0 +\- 1.2 mmag/yr averaged over the two warm Spitzer bands. Although the dimming is small, it is seen at >= 3 sigma by three different observatories operating from the UV to the IR. The presence of long-term secular dimming means that previous SED models of the star based on photometric measurements taken years apart may not be accurate. We find that stellar models with T_{eff} = 7000 - 7100 K and A_V ~ 0.73 best fit the Swift data from UV to optical. These models also show no excess in the near-simultaneous Spitzer photometry at 3.6 and 4.5 microns, although a longer wavelength excess from a substantial debris disk is still possible (e.g., as around Fomalhaut). The wavelength dependence of the fading favors a relatively neutral color (i.e., R_V >= 5, but not flat across all the bands) compared with the extinction law for the general ISM (R_V = 3.1), suggesting that the dimming arises from circumstellar material.Comment: accepted by the Astrophysical Journal; acknowledgements revised 9/1/201

Spitzer/IRAC Limits to Planetary Companions of Fomalhaut and epsilon Eridani

Fomalhaut and epsilon Eridani are two young, nearby stars that possess extended debris disks whose structures suggest the presence of perturbing planetary objects. With its high sensitivity and stable point spread function, Spitzer/IRAC is uniquely capable of detecting cool, Jupiter-like planetary companions whose peak emission is predicted to occur near 4.5 um. We report on deep IRAC imaging of these two stars, taken at 3.6 and 4.5 um using subarray mode and in all four channels in wider-field full array mode. Observations acquired at two different telescope roll angles allowed faint surrounding objects to be separated from the stellar diffraction pattern. No companion candidates were detected at the reported position of Fomalhaut b with 3 sigma model-dependent mass upper limits of 3 MJ (for an age of 200 Myr). Around epsilon Eridani we instead set a limit of 4 and <1 MJ (1 Gyr model age) at the inner and outer edge of the sub-millimeter debris ring, respectively. These results are consistent with non-detections in recent near-infrared imaging searches, and set the strongest limits to date on the presence of planets outside epsilon Eridani sub-millimeter ring.Comment: Accepted by The Astrophysical Journal. Request electronic-only plates to M. Marengo ([email protected]