Search

Background:. Unicompartmental and total knee arthroplasty (UKA and TKA) have demonstrated excellent mid- and long-term outcomes and have been compared in clinical series for decades; however, to our knowledge, no study has sufficiently matched UKA and TKA cohorts on preoperative osteoarthritis severity. The purpose of this study was to evaluate patient-reported outcomes of radiographically and demographically matched UKA and TKA cohorts. Methods:. One hundred and thirty-five UKAs and 135 TKAs were matched by patient age, sex, body mass index, and American Society of Anesthesiologists Physical Status (ASA-PS) classification as well as preoperative osteoarthritis severity in medial and lateral tibiofemoral and patellofemoral compartments (Kellgren-Lawrence grading system). Patient-reported outcome measures for pain, function, activity level, and satisfaction were evaluated at minimum 1-year follow-up via components of the modern Knee Society Score, the University of California Los Angeles (UCLA) activity-level score, and a Likert satisfaction scale. Results:. The patients in the UKA group reported significantly less pain, a higher activity level, and greater satisfaction while performing several functional activities and could walk for a longer amount of time before stopping due to knee discomfort compared with those in the TKA group (p ≤ 0.038). In addition, a greater proportion of patients in the UKA than in the TKA group were “satisfied or very satisfied” with their knee replacement surgery at minimum 1-year follow-up (90% versus 81%; p = 0.043). Conclusions:. With minimum 1-year follow-up, patients who underwent UKA reported significantly higher function, less pain, and a greater level of patient satisfaction than a radiographically and demographically matched TKA cohort. Level of Evidence:. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

ObjectiveAlthough posttraumatic stress disorder (PTSD) and chronic pain frequently occur in tandem, the pathophysiological mechanisms mediating this comorbidity are poorly understood. Because excessive inflammation occurs in both conditions, we examined the cerebrospinal fluid (CSF) concentrations of inflammatory response mediators interleukin 1-beta (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor-alpha (TNFα) and interleukin 10 (IL-10) after prolonged suprathreshold pain stimulus in 21 male combat veterans; 10 with PTSD and 11 combat controls (CC).MethodsAfter completing baseline quantitative sensory testing (QST) and psychological profiling, all patients received an injection of capsaicin into the quadriceps muscle. Spontaneously reported pain was measured for 30min after the capsaicin injection. The evoked pain measure of temporal summation was tested between 70 and 110min post capsaicin injection. Inflammatory (IL-1β, IL-6, IL-8 TNFα) and anti-inflammatory (IL-10) CSF cytokines were measured before (baseline) and after capsaicin injection over a time frame of 110min.ResultsFollowing intramuscular capsaicin injection, pro-inflammatory cytokines [TNFα, IL-6, IL-8] significantly increased (percent rise from baseline) in both groups, whereas IL-1β significantly increased in the PTSD group only. The anti-inflammatory cytokine IL-10 showed an immediate (within 10min) increase in the CC group; however, the IL-10 increase in the PTSD group was delayed and not consistently elevated until 70min post injection.ConclusionThese findings show significant central nervous system (CNS) differences in the inflammatory response to a deep pain stimulus in combat veterans with and without PTSD. They support the concept that abnormally elevated neuroinflammatory response to pain stimuli may be one CNS mechanism accounting for the high co-occurrence of PTSD and pain.

Outcomes following femoral reconstruction during revision total hip arthroplasty (THA) may be influenced by femoral deformity, fixation interface and implant type. The purpose of this study was to determine the long-term clinical and radiographic outcomes of a series of 461 femoral reconstructions with a calcar replacement prosthesis performed over a 21-year period. Multivariate analysis was performed based on age, femoral Paprosky class, implant length, modularity and mode of failure. Mean follow-up was 5.6 years. There were 18 stem revisions for an overall stem survivorship of 96.3%. Infection (n = 13) and dislocation (n = 2) were the most common indications for revision. Two stems were revised for aseptic loosening for an aseptic failure rate of 0.4%. Increased femoral deformities had higher revision rates due to all failure modes (p < 0.006). Overall complication rate was 13.4%, most commonly instability, infection and periprosthetic fracture, but most often did not lead to stem revision. We conclude that an uncemented bowed calcar replacement prosthesis has excellent clinical results in a wide range of femoral deformities, and most complications are unrelated to the femoral implant. All implants in this study have FDA approval. Berend ME, Ritter MA, Meding JB, Davis P. Twenty-one years Clinical Experience of 461 Femoral Revision Total Hip Arthroplasties with a Calcar Replacement Prosthesis. The Duke Orthop J 2012;2(1):1-4.

This article describes how one web site, Third Way Cafe, uses the Internet to introduce Anabaptist Christian perspectives into society's marketplace of ideas, and provides a prophetic witness on faith and contemporary issues. The article examines why Anabaptist Mennonites have historically worked at peace and justice issues, whether peace and justice can actually be furthered or accomplished on the web, how technology impacts the message, and what kinds of responses have come from the audience. The Internet, while not a face-to-face medium, has demonstrable capability for putting information at the fingertips of people who have keen (or marginal) interest in peacemaking and in connecting/providing a network for persons working and interested in peace and justice issues.

The Information Revolution has impacted the service philosophy of academic libraries; transformation has offered further opportunities for change in service. As the emphasis of academic librarianship moves away from collecting materials, the service philosophy will become a strong component of librarianship that is committed to access. Not only individual libraries, but all of academic librarianship, must transform. The service philosophy is the foundation of our future.

When men enter prison the lives of their partners change. This paper looks at men's prison sentences from the viewpoint of prisoners' partners. It examines the financial circumstances women find themselves in as the result of men's prison sentences as well as the social and personal consequences. It outlines the survival strategies women develop in the face of their difficulties and considers why the situation of prisoners' partners remains largely unacknowledged by state agencies and policy makers.

The OCLC Enhance program distributes quality control activities among member libraries. Libraries authorized to alter records are selcctcd because they input high quality cataloging. Libraries that are chosen are trained by OCLC in the policies and procedures of enhancing records. The University of Wyoming Library applied for Enhance authorization because it was concerned about data base quality. Enhancing is done by the OCLC Coordinator, who uses the opportunity to spot-check paraprofessional cataloging. Enhance participation has been worthwhile because it enables the Library to improve the quality of the data base, it is useful in training staff, and it contributes to Cataloging Department morale.