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BACKGROUND: Blood conservation and reduction in the need for allogeneic blood transfusion (ABT) has been a subject of importance in total hip arthroplasty. There are a number of well-recognized parameters that influence blood loss during total hip arthroplasty (THA). The role of surgical approach on blood loss and the rate of ABT during THA is not well studied. The hypothesis of this study was that blood loss and the need for ABT is lower with direct anterior (DA) approach. METHODS: In a case-control retrospective cohort study, we analyzed 1,524 primary THAs performed at a single institution by seven fellowship-trained surgeons between January 2015 to March 2017. All patients received THA using either the modified direct lateral (DL) or direct anterior (DA) approach using a standard operating table. The overall ABT rate was 10.2% (155/1,524) in the cohort. Demographic, surgical, and postoperative data were extracted and analyzed. Logistic regression was used to identify independent risk factors for transfusion. RESULTS: Higher preoperative hemoglobin (p

CASE A 76-year-old man presented with metastatic renal cell carcinoma (RCC) in the right acetabulum with pelvic compromise. The patient had right hip pain and difficulty with ambulation, as such he elected to undergo tumor resection with subsequent reconstruction of pelvic defect. Given the size and location of the anticipated pelvic defect, robotic-assisted hip arthroplasty was used to execute prosthetic component placement and anatomic pelvic reconstruction. CONCLUSION Advances in technology, such as robotics and 3D navigation, have application in orthopaedic oncology surgery, especially for reconstructions after pelvic resections. The goal of this case report is to describe the utility of this technology in a case of metastatic RCC.

Resumen La cirugia de reconstruccion articular de cadera y rodilla ha logrado grandes avances en los ultimos anos. Sin embargo, las infecciones periprotesicas (IPP) han permanecido con una incidencia relativamente constante, lo que representa un gran problema tanto para el paciente como para el cirujano, con altisimos costos economicos y emocionales. De esto se deriva que el ortopedista debe tener absoluta certeza en cuanto al diagnostico y manejo. En la presente revision presentamos las diferentes estrategias y conceptos en cuanto al diagnostico y manejo de las IPP de cadera y rodilla. Nivel de evidencia clinica Nivel IV.

Background Although periprosthetic joint infection (PJI) can affect multiple joints concurrently, the majority of patients with multiple prosthetic joints present with PJI of a single joint. Data regarding the optimal management of these patients are limited. We aimed to identify the prevalence, risk factors for a subsequent PJI, and clinical circumstances of PJI in patients with multiple prosthetic joints. Methods We retrospectively reviewed the clinical records of 197 patients with ≥2 total joint prostheses in place who presented with PJI from 2000 to 2017. The average follow-up was 3.6 years (range, 0.5 to 17 years). Demographic data and risk factors for synchronous or metachronous PJI were identified. The time from the initial to the second PJI and organism profile data were collected as well. The workup for other joints with a prosthesis in place at the time of the initial PJI was noted. Results Among the 197 patients with PJI and multiple joint prostheses in situ, 37 (19%) developed PJI in another joint; 11 had a synchronous PJI and 26 had a metachronous PJI. The average time between the first and the second infection in the metachronous cases was 848 days (range, 20 to 3,656 days). Females and patients with an initial PJI with methicillin-resistant Staphylococcus aureus (MRSA) were more likely to have a metachronous PJI, and patients with rheumatoid arthritis had an increased risk of a second (metachronous or synchronous) PJI. Three of 11 patients in the synchronous group and 19% (5) of the 26 in the metachronous group had bacteremia at the time of the initial PJI compared with 12% (19) of the 160 with a single PJI. The percentage of negative cultures increased from 10% for the initial PJIs to 38% for the metachronous PJIs. Conclusions Patients who have multiple prosthetic joints in place and present with PJI of a single joint are at risk of developing PJI in another joint. Female sex, rheumatoid arthritis, bacteremia at presentation, and infection with MRSA appear to be risk factors for PJI of another joint. Clinical evaluation of the other prosthetic joint(s) should be carried out in all patients and aspiration of those joint(s) should be considered for patients with any of the above risk factors. Level of evidence Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: There is an information gap in literature regarding postoperative outcome of total knee arthroplasty (TKA)in patients with hardware in-situ from the previous knee surgery. The present study aims to evaluate impact of retainedhardware on short-term outcome of TKA patients.Methods: Perioperative radiographs of patients who had undergone TKA between 2007 and 2012 were reviewedand patients in whom partial or complete retention of hardware was evident after TKA were included. These patientswere matched in 1 to 2 ratio based on age (+/- 2 years), gender, surgeon and year of surgery to a group of patientsthat underwent primary TKA without hardware in the affected knee. The average follow up of these patients was 43.45(range 12-155.2) months. Complication rates were compared between the two groups using statistical tests that tookinto account the matched data structure.Results: We included a total of 55 cases and 110 controls. The incidence of complications was higher, although notall statistically significant, in the case group. Only mechanical complications were significantly different in the casesgroup (5.5% versus 0%, P=0.01). Time to event analysis using the mixed-effects Cox model didn’t show a statisticallysignificant difference between two groups for various outcomes.Conclusion: Presence of retained hardware around the knee may predispose the patient to a higher rate ofcomplications particularly mechanical complications of the implant after TKA. Further studies are required to investigateimpact of retained hardware around the knee in patients undergoing TKA.

El objetivo del estudio fue investigar la incidencia de la inversión pública en sus tres niveles de gobierno (la inversión que realiza directamente el Gobierno Nacional, la inversión de los gobiernos regionales y la inversión de los gobiernos locales) sobre la reducción de la pobreza estructural para el caso peruano a partir de información departamental (2008-2015). Los resultados muestran que la incidencia de cada uno de estos niveles de gobierno sobre la pobreza estructural ha sido diferente, así encontramos que la inversión de los gobiernos locales ha sido la que más ha contribuido a la reducción de la pobreza, seguido por los programas nacionales; sin embargo, la inversión de los gobiernos regionales todavía no logra el resultado esperado y debe optimizarse. Se enfatiza la necesidad de implementar planes de desarrollo coordinado para mejorar la eficacia de la inversión pública. Al mismo tiempo, este trabajo en el aspecto académico, ha permitido emplear el Modelo de Datos de Panel como técnica econométrica de análisis y como mecanismo para suplir escasez de información.

Background Giant cell tumours (GCT) of the bone are benign and consist of aggressive local growth with rare metastatic disease. Its reported incidence in the immature skeleton is less than 10%, ranging from 1.8% to 10.6%. Few GCT series have been reported in the immature skeleton. In our ?country?, the overall incidence and impact of GCT in these patients is unknown. A series of 11 cases is presented, demonstrating their demographic characteristics, treatment, and follow-up.

Los flujos de capitales (de corto y largo plazo) han tenido significativa relación con el crecimiento económico en el Perú, a lo largo de un período de 64 años, divididos en períodos bastante diferenciados. La división del período de estudio ha respondido a los diferentes modelos económicos implantados en su momento.Un primer período abarca desde 1950 hasta 1970, con predominio de una economía primario-exportadora; un segundo período de 1971 a 1990, con prevalencia de una corriente económica de sustitución de importaciones y un tercer período de 1991 al año 2014, con el regreso de una tendencia que privilegia la economía primario-exportadora y de carácter extractivista, con gran dependencia de las exportaciones mineras, agroexportadoras y pesqueras. El objetivo de la investigación es determinar en qué medida los flujos de capitales de corto y largo plazo inciden en el crecimiento del producto bruto interno del Perú, en el período 1950 – 2014. Además, se ha incorporado al análisis de los datos, las técnicas econométricas del uso de vectores auto regresivos (VEC), del mecanismo de corrección de errores (MCE) y de la cointegración como aporte académico al estudio de temas económicos, los cuales han resultado satisfactorios.

Resumen Introduccion El tratamiento de las fracturas metafisarias distales del radio despierta controversia. Esta ha aumentado con el advenimiento de tecnicas basadas en fijacion interna con placas bloqueadas y es notable el aumento de preferencia de cirujanos y pacientes por este metodo. Sin embargo, su beneficio no ha sido probado en las fracturas extraarticulares. Esto nos impulso a iniciar un estudio que nos permitiera definir el mejor metodo de manejo para este grupo de fracturas. Materiales y metodos Experimento clinico controlado en que se comparan dos metodos de fijacion para fracturas extraarticulares del radio distal en adultos: reduccion cerrada con fijacion percutanea (grupo 0) y reduccion abierta y fijacion interna con placa bloqueada por via palmar (grupo 1). Se realizo seguimiento radiologico y clinico durante 52 semanas en intervalos postoperatorios seriados. Resultados Se incluyo a 77 pacientes (grupo 0: 36; grupo 1: 31), el seguimiento a 6 y 12 semanas fue satisfactorio, pero hubo una alta desercion para los controles a las 26 y 52 semanas. No hubo diferencias entre los dos metodos en cuanto a consolidacion y calidad de la reduccion. Hubo diferencias en la fuerza y la movilidad con ventaja para la reduccion abierta con fijacion interna. Discusion El estudio logro demostrar resultados radiologicos y clinicos similares para los dos grupos de estudio a corto plazo. No hubo diferencias importantes en cuanto a complicaciones. Se demostro una diferencia importante estadisticamente en cuanto a costo con ventaja para la reduccion cerrada y fijacion percutanea. La perdida de seguimiento de la muestra impide emitir conclusiones respecto al resultado a medio plazo y, por tanto, tampoco se ofrecen recomendaciones. Nivel de evidencia clinica Nivel II.

Resumen El tumor de celulas gigantes de la vaina sinovial del tendon (TCGVS) es la segunda lesion mas frecuente de la mano y la muneca, y el 85% de estos tumores se originan en los dedos. Su localizacion mas frecuente es en los tres digitos radiales, especialmente en las articulaciones interfalangicas distales. La sobreexpresion de factor estimulante de colonias 1 (CSF1) se ha visto en la sinovitis vellonodular pigmentada (SVP) y en los TCGVS. Se reporta hasta el 50% de tasa de recurrencia. Con frecuencia, las recurrencias se tratan principalmente con resecciones quirurgicas amplias que pueden implicar la amputacion y el compromiso funcional de la mano. Presentamos el caso de una recurrencia de un TCGVS en un paciente con una lesion invasiva ubicada en el tendon del flexor profundo del pulgar que infiltraba toda la region tenar tratada mediante reseccion quirurgica e imatinib. El tumor de celulas gigantes puede responder a la terapia sistemica y esta opcion de tratamiento puede ser considerada en pacientes con margenes inadecuados o en zonas no accesibles. Adecuados resultados funcionales se pueden esperar con el tratamiento quirurgico y farmacologico combinado. Nivel de evidencia clinica Nivel IV.

Resumen Introduccion La incidencia de luxacion en reemplazos de cadera es mayor en pacientes con alto riesgo de inestabilidad. El uso de copas de doble movilidad (CDM) tiene menor incidencia de luxacion que el de las protesis convencionales. Materiales y metodos Estudio de cohorte retrospectiva. Pacientes llevados a reemplazo total de cadera (RTC) entre 2011 y 2014, con copas de doble movilidad, operados por abordaje posterolateral por el mismo grupo de cirujanos. Se evaluo la incidencia de luxacion y la razon de utilizar CDM. Las diferencias entre grupos se calcularon mediante la prueba exacta de Fisher para las variables cualitativas y el test de Wilcoxon para las variables continuas. Resultados Se incluyo a 103 pacientes con una media de edad de 79,5 anos, el 73,7% de los cuales eran mujeres. Las principales razones para usar CDM fueron: fractura de cadera (65%) y revision (31%). La incidencia de luxacion protesica alcanzo el 7,7% y se presento principalmente en mujeres (87,5%; p = 0,677). De los pacientes que presentaron luxacion, el 87,5% tenia fractura y el 63%, enfermedad de la esfera mental. Discusion La luxacion protesica continua siendo un problema, incluso con el uso de CDM, en pacientes de alto riesgo. La incidencia de luxacion en fracturas y cirugia de revision en nuestra institucion es similar a la reportada en la bibliografia. Observamos que en nuestro estudio las luxaciones se presentaron principalmente en pacientes que tenian como factor de riesgo fractura y alteracion de la esfera mental, lo que puso de manifiesto que este segundo factor tenia gran importancia. Nivel de evidencia clinica Nivel IV. Estudio observacional.

Objective: To evaluate the learning style (EEAA) and its relation with the academic performance (RA), in Nursing Interns of a national university of Peru. Methods: Cross-sectional, quantitative, correlational study; conducted in 70 nursing interns during 2018, the Honey-Alonso validated questionnaire (CHAEA) was applied for learning styles and record of grades for academic performance, the data were submitted to descriptive and inferential statistics, using SPSS 26.0. Results: The population characteristics, according to age, 84.5% were between 20 and 25 years old, usually single, do not work, although a significant group does, and 82.9% women. In EEAA reflexive learning (0.80) predominates, followed by theoretical (0.75), pragmatic (0.66) and active (0.57). The weight average of R.A. It was 15.84, with a good and excellent qualification, 62.86% presented a good performance, followed by 32.86% with excellent performance. The results of association between EEAA and RA were not significant (P> 0.05). Conclusion: The academic performance of nursing interns was mainly good and excellent. The EEAA evaluation showed the reflexive style as predominant. We found no significant association between learning styles and their contribution to academic performance. Objetivo: Evaluar los estilos de aprendizaje (EEAA) y su relación con el rendimiento académico (RA), en Internos de Enfermería de una universidad nacional del Perú. Métodos: Estudio transversal, cuantitativo, correlacional; realizado en 70 internos de enfermería durante el año 2018, se aplicó el cuestionario validado de Honey-Alonso (CHAEA) para estilos de aprendizaje y record de notas para rendimiento académico, los datos fueron sometidos a estadística descriptiva e inferencial, utilizando el SPSS 26.0. Resultados: Características de población, según edad 84,5% entre 20 a 25 años, generalmente solteros, no trabajan, aunque un grupo significante si lo hace, 82,9% de sexo femenino. En EEAA predomina el aprendizaje reflexivo (0.80), seguido del teórico (0.75), pragmático (0.66) y activo (0.57). El promedio ponderal de R.A. fue de 15.84 predominando la calificación bueno y excelente, 62.86% presentaron un rendimiento bueno, seguido de 32,86% con rendimiento excelente. Los resultados de asociación entre EEAA y RA fueron no significativos (P>0,05). Conclusión: El rendimiento académico de los internos de enfermería fue principalmente bueno y excelente. La evaluación del EEAA mostró al estilo reflexivo como predominante. No encontramos asociación significativa entre los estilos de aprendizaje y su contribución al rendimiento académico.

Many surgeons add topical antibiotics to irrigation solutions assuming that this has a local effect and eliminates bacteria. However, prior studies have suggested that the addition of antibiotics to irrigation solution confers little benefit, adds cost, may potentiate anaphylactic reactions, and may contribute to antimicrobial resistance. We sought to compare the antimicrobial efficacy and cytotoxicity of an irrigation solution containing polymyxin-bacitracin with other commonly used irrigation solutions.Staphylococcus aureus and Escherichia coli were exposed to irrigation solutions containing topical antibiotics (500,000-U/L polymyxin and 50,000-U/L bacitracin; 1-g/L vancomycin; or 80-mg/L gentamicin), as well as commonly used irrigation solutions (saline solution 0.9%; povidone-iodine 0.3%; chlorhexidine 0.05%; Castile soap 0.45%; and sodium hypochlorite 0.125%). Following 1 and 3 minutes of exposure, surviving bacteria were manually counted. Failure to eradicate all bacteria in any of the 3 replicates was considered not effective for that respective solution. Cytotoxicity analysis in human fibroblasts, osteoblasts, and chondrocytes exposed to the irrigation solutions was performed by visualization of cell structure and was quantified by lactate dehydrogenase (LDH) activity. Efficacy and cytotoxicity were assessed in triplicate experiments, with generalized linear mixed models.Polymyxin-bacitracin, saline solution, and Castile soap at both exposure times were not effective at eradicating S. aureus or E. coli. In contrast, povidone-iodine, chlorhexidine, and sodium hypochlorite irrigation were effective against both S. aureus and E. coli (p0.001). Vancomycin irrigation was effective against S. aureus but not against E. coli, whereas gentamicin irrigation showed partial efficacy against E. coli but none against S. aureus. Within fibroblasts, the greatest cytotoxicity was seen with chlorhexidine (mean [and standard error], 49.38% ± 0.80%; p0.0001), followed by Castile soap (33.57% ± 2.17%; p0.0001) and polymyxin-bacitracin (8.90% ± 1.40%). Povidone-iodine showed the least cytotoxicity of the efficacious solutions (5.00% ± 0.86%). Similar trends were seen at both exposure times and across fibroblasts, osteoblasts, and chondrocytes.Irrigation with polymyxin-bacitracin was ineffective at bacterial eradication, and statistically inferior to povidone-iodine. Chlorhexidine lavage conferred the greatest in vitro cytotoxicity.These data suggest that the addition of polymyxin-bacitracin to saline solution irrigation has little value. Given the cost and antimicrobial resistance implications, our findings, combined with prior clinical literature, provide adequate reason to avoid widespread use of antibiotics in irrigation solutions. Povidone-iodine may be a more effective and safer option.

Total knee arthroplasty (TKA) is a highly successful operation that improves patients' quality of life and functionality. Yet, up to 20% of TKA patients remain unsatisfied with their clinical result. Robotic TKA has gained increased attention and popularity as a means of improving patient satisfaction. The promise of robotic-assisted TKA is that it provides a surgeon with a tool that accurately executes bone cuts according to presurgical planning, as well as provides the surgeon with intraoperative feedback helpful for restoring knee kinematics and soft tissue balance. Several systems are now available, each with their own advantages and disadvantages. Evidence that the use of robotics will lead to improved implant survival, function, and patient-reported outcomes is slowly being accumulated, but this has not been clearly proven to date. Recent literature does show that the use of robotics during TKA is not associated with increased surgical time or complications. The goal of this review is to provide an objective assessment of the evidence surrounding robotic technology for TKA. © 2019 2019 by Thieme Medical Publishers, Inc. All rights reserved.

To investigate whether surgery for Periprosthetic Joint Infection (PJI) of the hip, the number of procedures and their duration contribute to risk of Heterotopic Ossification formation.56 patients with hip PJI undergoing one-stage (10) or two-stage (46) exchange arthroplasty were matched to 112 patients undergoing revision arthroplasty for aseptic failure based on age, gender, body mass index (BMI), surgical approach (all direct lateral) and date of surgery (2006-2013). Patients with Paget's disease and ankylosing spondylitis, or preoperative HO were excluded. Perioperative pain management included use of the anti-inflammatory medications in all patients without prophylactic radiotherapy. Six-month postoperative radiographs were reviewed based on Brooker classification.The incidence of overall HO in PJI and aseptic groups was 84% (47/56) and 11% (12/112), respectively. High grade HO (grades 3 and 4) in PJI and aseptic groups were 25% (24/56) and 4% (4/112), respectively. PJI was an independent risk factor for HO in the multivariate analysis (odds ratio of 9.3, 95% CI: 2.9-29.9,Patients undergoing surgical treatment of hip PJI seem to be at increased risk of developing HO compared to aseptic failure. HO prophylaxis regimens may be recommendable in eligible patients undergoing surgical intervention for PJI of the hip.IV.

Background: It is strongly recommended that tissue and synovial fluid culture samples be obtained during reimplantation performed as part of a 2-stage exchange arthroplasty. The rate of positive cultures during reimplantation and the influence of positive cultures on subsequent outcomes, to our knowledge, are unknown. This study was designed to determine the rate of positive cultures during reimplantation and to investigate the association between positive cultures at reimplantation and subsequent outcomes. Methods: We retrospectively reviewed the data of 259 patients who met the Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI) and who underwent both stages of 2-stage exchange arthroplasty at our institution from 1999 to 2013. Among these patients were 267 PJIs (186 knees and 81 hips); 33 (12.4%) had ≥1 positive culture result at reimplantation. Treatment failure was assessed according to the Delphi-based consensus definition. Logistic regression analysis was performed to assess the predictors of positive culture and risk factors for failure of 2-stage exchange arthroplasty. Results: Of the 33 cases with PJI, 15 (45.5%) had a subsequent failure of the 2-stage exchange arthroplasty compared with 49 (20.9%) of the cases that were culture-negative at reimplantation. When controlling for other variables using multivariate analyses, the risk of treatment failure was higher (odds ratio = 2.53; 95% confidence interval [CI] = 1.13 to 5.64) and reinfection occurred earlier (hazard ratio = 2.00; 95% CI = 1.05 to 3.82) for the cases with a positive culture during reimplantation. The treatment failure rate did not differ (p = 0.73) between cases with ≥2 positive cultures (36.4%) and 1 positive culture (50%). Conclusions: Positive intraoperative culture at the time of reimplantation, regardless of the number of positive samples, was independently associated with >2 times the risk of subsequent treatment failure and earlier reinfection. Surgeons should be aware that a positive culture at the time of reimplantation independently increases the risk of subsequent failure. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Purpose The aim of this study was to compare the radioguided occult lesion localization (ROLL) technique with the wire-guided lesion localization (WGLL) technique to assess their efficacy and accuracy in the localization of nonpalpable breast lesions in patients at a unique reference medical center. These patients’ reports were negative for malignancy but included highly suspicious imaging findings. Methods A controlled clinical trial was designed to compare the WGLL and ROLL techniques in women presenting with breast lesions diagnosed by mammography or ultrasonography at the Instituto Nacional de Cancerologia in Bogota, Colombia, from March 2006 to June 2011. Results This study examined 129 patients; 64 (49.6%) patients were treated with ROLL, and 65 (51.4%) were treated with WGLL. The ROLL technique achieved better median lesion centricity (ROLL = 11.7 and WGLL = 15.4; P = .038). No significant differences were found regarding demographic variables, operative specimen characteristics, the need to extend margins, operative complications, the degree of difficulty, or patient or surgeon satisfaction. Conclusion The ROLL technique is as effective as WGLL for the localization of nonpalpable breast lesions. In our study, ROLL achieved better lesion centricity. Therefore, we propose that this technique could be used as a standard procedure in the detection of nonpalpable breast lesions at experienced centers.

Introducción: El COVID-19 modificó radicalmente las agendas informativas de los medios de comunicación, considerando el vuelco que provocó en la economía global y la cotidianidad de las personas. En este contexto, los medios han sido referentes en la construcción de la realidad y la información pública durante la pandemia. Objetivos: La presente investigación identificó los personajes, instituciones, territorios, temas, controversias y estilos de vida asociados a la pandemia del COVID-19, revelados a través de los contenidos de dos medios de comunicación de Ecuador y Colombia. Metodología: Empleando el Método Histórico-Discursivo (MHD), se analizaron los artículos sobre COVID-19 publicados en la versión digital de los periódicos Expreso, de Guayaquil (Ecuador), y El País, de Cali (Colombia) durante los meses de marzo y abril de 2020. Resultados: El análisis reveló las tensiones entre el ejercicio político y las prioridades sanitarias. Se denota que los alcaldes de Guayaquil y Cali fueron el foco de la información, y que se priorizaron los datos epidemiológicos y la información sobre medidas sanitarias. Conclusión: Nuestro estudio estableció que el cubrimiento sobre el COVID-19 enfocado en los datos de la pandemia, no contribuyó a que los ciudadanos asimilaran el riesgo de la enfermedad, y a que mantuvieran estilos de vida que hicieron que el número de contagios creciera de forma exponencial.

Case A 29-year-old man was admitted with acute atraumatic left hip pain and inability to bear weight. Subsequent workup revealed an intracapsular pathologic fracture of the femoral neck secondary to a high-grade spindle cell sarcoma. A unique method of extra-articular resection and reconstruction using a 3-dimensional (3D)-printed custom cutting jig and a custom acetabular component was pursued. Wide margins were achieved without violating the joint capsule but preserving pelvic integrity, allowing a return to an active lifestyle. Conclusion Three-dimensional-printed custom resection guides and implants can help achieve adequate resection margins while preserving pelvic integrity and function.

Whether prolonged operative time is an independent risk factor for subsequent surgical site infection (SSI) and periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant and underexplored issue. The aim of this study is to investigate the association between operative time and the risk of subsequent SSI and PJI in patients undergoing primary TJA.We retrospectively reviewed 17,342 primary unilateral total knee arthroplasty and total hip arthroplasty performed at a single institution between 2005 and 2016, with a minimum follow-up of 1 year. A multivariate logistic regression model was conducted to identify the association between operative time and the development of SSI within 90 days and PJI within 1 year.Overall, the incidence of 90-day SSI and 1-year PJI was 1.2% and 0.8%, respectively. Patients with an operative time of90 minutes had a significantly higher incidence of SSI and PJI (2.1% and 1.4%, respectively) compared to cases lasting between 60 and 90 minutes (1.1% and 0.7%), and those lasting ≤60 minutes (0.9% and 0.7%, P.01). In the multivariate model, the risk for infection increased by an odds ratio of 1.346 (95% confidential interval 1.114-1.627) for 90-day SSI and 1.253 (95% confidential interval 1.060-1.481) for 1-year PJI for each 20-minute increase in operative time.In patients undergoing primary TJA, each 20-minute increase in operative time was associated with nearly a 25% increased risk of subsequent PJI. We advocate that surgeons pay close attention to this underappreciated risk factor while maintaining safe operative practices, which minimize unnecessary steps and wasted time in the operating room.

Background Our experience with direct anterior approach total hip arthroplasty (THA) suggests that it can be performed successfully with a morphometrically optimized metaphyseal-diaphyseal engaging femoral stem (NOT a short stem), a regular operating room table (NOT a special custom table), and WITHOUT intraoperative fluoroscopy. We report our minimum 2-year results. Methods A retrospective review of a single-surgeon series of primary direct anterior approach THAs was performed. All procedures were performed on a regular table, without fluoroscopy, using a cementless tapered femoral stem. Clinical, functional, and radiographic outcomes were evaluated at a minimum of 2 years. Results In total, 1017 primary THAs were performed. The preoperative Harris Hip Score was 40.7 ± 5.1 and improved to 95.3 ± 4.2 at minimum 2-year follow-up. There were 3 dislocations (0.3%) and 15 revisions (1.5%): 7 for infection (0.7%), 4 for periprosthetic fractures (0.4%), 2 for instability (0.2%), 1 for loosening (0.1%), and 1 for pain (0.1%). Five patients (0.5%) required blood transfusion. One patient developed deep vein thrombosis and pulmonary embolism. No intraoperative fractures, perforation, or THA-related mortality occurred. Neutral stem alignment was confirmed in 98.3%. Mean cup inclination was 38.8° ± 5.1° and anteversion was 16.2° ± 3.5°. The mean leg-length discrepancy was corrected from 1.2 ± 0.2 cm preoperatively to 0.2 ± 0.1 cm postoperatively. Conclusion Using a morphometrically optimized metaphyseal-diaphyseal engaging tapered femoral stem instead of a short stem reduces component malposition and minimizes risk of loosening. Combining the use of this implant design and the technique and elements described in our cohort demonstrated to have excellent results at 2 years. The patients will need continued follow-up to demonstrate further durability of this device and technique compared to others performing direct anterior THA.

Resumen: Este artículo presenta los resultados de un estudio piloto sobre las prácticas de consumo cultural mediático de jóvenes estudiantes colombianos. Su objetivo es reflexionar sobre el papel del sistema educativo en el desarrollo de la competencia mediática. Para ello, se estructuró un instrumento para caracterizar estas prácticas, a partir de variables como preferencia, razones, tiempo invertido, forma de acceso, compañía y posibilidades de consumo en distintos escenarios. El instrumento aún no cuenta con un proceso de validación estadística, pero los datos obtenidos aportan elementos teóricos, conceptuales y metodológicos significativos Abstract: This article presents the results of a pilot study on the cultural media consumption practices of young Colombian students. Its aim is to reflect on the role of the educational system in the development of media competence. To this end, an instrument was structured to characterize these practices, based on variables such as preference, reasons, time invested, form of access, company and consumption possibilities in different scenarios. The instrument does not yet have a statistical validation process, but the data obtained provide significant theoretical, conceptual and methodological elements

Background: Underweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion. Methods: A case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] < 18.5 kg/m2) from 2000-2012 and were matched for age, gender, date of surgery, age-adjusted Charlson comorbidity index, rheumatoid arthritis, and diabetes. These patients were compared to 81 normal weight patients (BMI 18.5-24 kg/m2). Demographic variables were compared, along with wound complications, surgical site infection (SSI), blistering, deep vein thrombosis, pulmonary embolism, transfusion, revision, flexion contracture, hematoma formation, and patellar clunk. Results: The average BMI was 17.1 kg/m2 (range 12.8-18.4) for UW and 23.0 kg/m2 (range 19.0-25.0) for normal weight patients (P < .001). UW TKA patients were more likely to develop SSIs (3/27, 11.1% vs 0/81, 0.0%, P = .01) and were more likely to require transfusions (odds ratio = 3.4, confidence interval 1.3-9.1; P = .02). Conclusions: Our study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The specific reasons are unclear, but we conjecture that it may be related to decreased wound healing capabilities and low preoperative hemoglobin. Investigation of local tissue coverage and hematologic status may be beneficial in this patient population to prevent SSI. Based on the results of this study, a prospective evaluation of these factors should be undertaken.

Irrigation and debridement with prosthetic retention (ID) is an oft-utilized treatment option for PJI, despite its known limited success. While it is known that nearly half of all patients treated with ID have recurrent infection, the organism persistence between infection events remains unreported. In addition, identifying those cases in which ID routinely failed to eradicate the infection (not simply prevent recurrent infection) may allow improved patient selection for this less morbid procedure-a difficult task to date.Using an institutional database, 146 patients (153 joints) undergoing ID between April 2000 and July 2013 were identified. There were 60 hips (40%). The overall success rate of ID in this group was 52% (80/153). The failure group was limited to those patients with growth on culture at both initial failure and recurrent failure (46 cases). Analyses were performed to identify potential predictors of failed ID and organism persistence in those cases.In the study group, 83.7% (36/43) of cases failed with the same organism. Knees with failed ID had an organism persistence of 92.3% (24/26) compared with 70.5% (12/17; P = .09) for the hip. Patients initially infected with Staphylococcus aureus (specifically methicillin-resistant [13/13]) had a higher risk of persistent PJI (96%; 24/25) compared to other organisms (66.7%; 12/18; P = .01).ID had a success rate of approximately 50% and typically failed due to organism persistence rather than a new infection. Given that persistent infection was most common in knees and S aureus, ID should have a limited role in treating PJI, especially in these cases.

Resumen Los estudios de imagenes en patologia mamaria han permitido detectar lesiones que clinicamente no son palpables y que requieren estudio con biopsia percutanea. Si el informe del estudio histopatologico es insuficiente, sospechoso o confirmatorio de malignidad, es necesario recurrir a su reseccion quirurgica. Este procedimiento plantea un reto para el cirujano oncologo, quien dispone de varias tecnicas, dentro de las cuales la mas utilizada es la marcacion por arpon. Otra alternativa utilizada desde hace mas de diez anos es la Tecnica de ROLL (por sus siglas del ingles radioguided occult lesion localization), que ademas de ser un arma adecuada para enfrentar a las pacientes con lesiones no palpables, ofrece ventajas como menores volumenes de reseccion y baja incidencia de margenes positivos. El presente articulo describe la tecnica de ROLL para la localizacion de lesiones no palpables de la mama.

Objective: To describe the initial experience of isolated limb perfusion at the National Cancer Institute. Methods: Pathology and response to intervention was documented in the cases of 13 patients taken from years 2007 to 2008. Results: Limb salvage was 76%; local complications, 16%. Five patients (41.7%) had partial response; two more (16.7%), disease progression. No patients had complete clinical response. Conclusions: Isolated limb perfusion provides a good alternative for treating melanoma and advanced sarcomas in limbs; possibly sparing them from amputation. Due to the number of patients included in this article, and to the need to establish more solid conclusions, it is necessary to carry out closer patient follow-up by setting up a prospective research project whose results will establish type of response, disease free interval, overall survival and a quality-of-life scale for patients who receive this kind of treatment.

Background: Two-stage exchange arthroplasty remains the preferred method to treat periprosthetic joint infection. The aim of this study was to investigate the clinical course of periprosthetic joint infection following resection arthroplasty and insertion of a spacer. Methods: Our institutional database was used to identify 504 cases of periprosthetic joint infection (326 knees and 178 hips) treated with resection arthroplasty and spacer insertion as part of a two-stage exchange arthroplasty. A review of the patient charts was performed to extract information relevant to the objectives of this study that included the details of the clinical course following resection arthroplasty. Results: The mean follow-up duration after initial spacer implantation was 56.2 months. Reimplantation occurred in the joints of 417 (82.7%) of 504 cases. Of these 417 cases, 329 (78.9%) had a minimum one-year follow-up, and 81.4% of these had successful treatment. The mean duration from resection arthroplasty to reimplantation was 4.2 months (range, 0.7 to 131.7 months). Sixty (11.9%) of the 504 joints required interim spacer exchange(s). Of the eighty-seven cases that did not undergo reimplantation, six (6.9%) required amputation, five (5.7%) underwent a Girdlestone procedure, four (4.6%) underwent arthrodesis, and seventy-two (82.8%) underwent spacer retention. Thirty-six patients died in the interstage period. Conclusions: The commonly held belief that two-stage exchange arthroplasty carries a high success rate for the eradication of periprosthetic joint infection may need to be reexamined. A considerable number of patients undergoing the first stage of a two-stage procedure do not undergo a subsequent reimplantation for a variety of reasons or require an additional spacer exchange in the interim. Reports on the success of two-stage exchange should account for the mortality of these patients and for patients who never undergo reimplantation. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

After the successful treatment of periprosthetic joint infection (PJI), patients may present with degenerative joint disease in another joint with symptoms severe enough to warrant arthroplasty. However, it is not known whether patients with a history of treated PJI at one site will have an increased risk of PJI in the second arthroplasty site.The primary objective of this study is to determine if there is a difference in the risk of developing a PJI after a second total hip arthroplasty (THA) or total knee arthroplasty (TKA) in patients who have had a previous PJI at another anatomic site compared with patients who have had no history of PJI. The secondary objective is to determine other potential risk factors that may predict PJI at the site of the second arthroplasty.A retrospective matched cohort study was performed to identify all patients at four academic institutions successfully treated for PJI who subsequently underwent a second primary THA or TKA (n = 90), constituting our study group. Patients were matched (one-to-one) to control subjects who had no history of PJI after their first arthroplasty (n = 90); they were matched based on age, sex, diabetic status, BMI, American Society of Anesthesiologists, institution, joint of interest, and year of surgery (± 2 years). We compared the case and control groups to determine whether a prior infection increased the relative risk of a subsequent PJI at another anatomic site. To identify other potential risk factors for subsequent PJI, a subgroup univariate analysis of our study group (n = 90) was performed. To identify other potential risk factors for subsequent PJI, a subgroup univariate analysis of our study group (n = 90) was performed.Patients with a history of PJI had a greater risk of developing PJI in a subsequent THA or TKA (10 of 90 versus zero of 90 in the control group; relative risk, 21.00; 95% confidence interval [CI], 1.25-353.08; p = 0.035). Excluding PJI, we identified no other factors associated with a second joint infection. In patients with a history of PJI, a second PJI occurred more frequently in female patients (female: nine of 10 [90%] versus female: 40 of 80 [50%]; odds ratio [OR], 8.83; 95% CI, 1.13-403.33; p = 0.02) and in those whose initial infection was a staphylococcal species (subsequent PJI seven of 10 [70%] versus no subsequent PJI 28 of 80 [35%]; OR, 4.26; 95% CI, 0.89-27.50; p = 0.04).A history of PJI predisposes patients to subsequent PJI in primary THA or THA. Patients and surgeons must be aware of the higher risk of this devastating complication before proceeding with a second arthroplasty.Level III, prognostic study.