Trunnionosis is defined as wear of the femoral head–neck interface and has recently been acknowledged as a growing cause of total hip arthroplasty failure. Some studies have reported that it accounts for up to 3 % of all revisions. The exact cause of trunnionosis is currently unknown; however, postulated etiologies include modular junction wear, corrosion damage, and metal ion release. Additionally, implant design and trunnion geometries may contribute to the progression of component failure. In order to aid in our understanding of this phenomenon, our aim was to present the current literature on (1) the effect of femoral head size on trunnionosis, (2) the effect of trunnion design on trunnionosis, (3) localized biological reactions associated with trunnionosis, and (4) gross trunnion failures. It is hoped that this will encourage further research and interest aimed at minimizing this complication.

Background Dislocation complicates 1% to 5% of primary total hip arthroplasties (THAs). As a result, some surgeons consider dual-mobility articulations, which are usually used in the revision setting to decrease the likelihood of dislocation, as an option for primary THA. However, few studies have evaluated their use in this setting. Questions/purposes (1) What is the cup survivorship when the dual-mobility articulation is used in the setting of primary THA? (2) What are the clinical outcomes with this approach? (3) What are the radiographic outcomes? (4) What are the complications of dual-mobility articulations in primary THA? Methods Between 2011 and 2013, the five participating surgeons performed 495 cementless primary THAs. During that time, one of the five surgeons used dual-mobility articulations for all THAs, and the other four used it whenever the acetabular cup size was 52 mm or greater to enable a 28-mm head. Of the 495 patients, 453 (92%) were performed using this device. Smaller patients were treated with a standard THA. Of the 453 patients, a total of 43 One of the authors certifies that he (PMB) has received or may receive payments, during the study period, an amount of USD 100,000 to USD 1,000,000 from Stryker Orthopaedics (Mahwah, NJ, USA) and an amount of USD 10,000 to USD 100,000 from Joint Active Systems (Effingham, IL, USA). One of the authors certifies that he (SFH) has received or may receive payments, during the study period, an amount of USD 100,000 to USD 1,000,000 from Stryker Orthopaedics, less than USD 10,000 from Slack Inc (Thorofare, NJ, USA), an amount of USD 10,000 to USD 100,000 from Convatec, and less than USD 10,000 from Thieme Inc (New York, NY, USA). One of the authors certifies that he (ALM) has received or may receive payments, during the study period, an amount of USD 100,000 to USD 1,000,000 from Stryker Orthopaedics. One of the authors certifies that he (FRK) has received or may receive payments, during the study period, an amount of USD 100,000 to USD 1,000,000 from Stryker Orthopaedics and an amount of USD 10,000 to USD 100,000 from DJ Orthopedics (Vista, CA, USA). One of the authors certifies that he (MAM) has received or may receive payments, during the study period, an amount of USD 100,000 to USD 1,000,000 from Stryker Orthopaedics, an amount of USD 10,000 to USD 100,000 from DJ Orthopedics, an amount of USD 10,000 to USD 100,000 from Microport (Arlington, TN, USA), an amount of USD 10,000 to USD 100,000 from J&J (New Brunswick NJ, USA), an amount of USD 10,000 to USD 100,000 from Medical Compression Systems (Tel Aviv, Israel), an amount of USD 10,000 to USD 100,000 from OnGoing Care Solutions (Pinellas Park, FL, USA), an amount of USD 10,000 to USD 100,000 from Sage Products LLC (Cary, IL, USA), an amount of USD 10,000 to USD 100,000 from TissueGene (Rockville, MD, USA) an amount of USD 10,000 to USD 100,000 from Pacira Pharmaceuticals (Parsippany, NJ, USA), an amount of USD 10,000 to USD 100,000 from Merz (Frankfurt, Germany), and an amount of USD 10,000 ...

Background Cutibacterium acnes is the primary cause of shoulder surgery infections, but the predisposition to larger skin counts and potentially higher risk for postoperative infection remains unclear. This study aimed to quantify risk factors influencing endogenous C. acnes burden and to compare counts among 4 shoulder sites. Methods C. acnes counts were quantified via a detergent scrub technique for 173 participants. Bivariate and multivariable stepwise linear regression statistical analyses were used to investigate the association of sex, age, ethnicity, degree of hirsutism, diabetes, smoking status, body mass index, and location with counts. A separate Wilcoxon rank-sum test was performed analyzing counts of East/Southeast Asians vs. all other ethnicities. Results Sex, age, degree of hirsutism, diabetes, smoking status, and body mass index were included in the multivariable stepwise linear regression analysis. The multiple regression analysis isolated individuals <40 years with the highest burden ( P = .001). Males had a 191% increase in C. acnes counts compared with females ( P = .001). Increased hirsutism was further indicated to be a risk factor for the male sex although not in a dose-dependent manner ( P = .027). Wilcoxon rank-sum test results found that East/Southeast Asians had the lowest load ( P = .019), although not significant in the multivariate model. Conclusion Surgical site C. acnes infections occur more frequently in younger males, and males <40 years with shoulder-specific hirsutism have the highest preoperative burden. East/Southeast Asians have lower raw counts of C. acnes compared with other ethnicities that may be related to less hirsutism.

Varicella-zoster is the causative virus underlying varicella or “chickenpox” and herpes zoster or “shingles.” Cases of disseminated disease have been widely reported in immunocompromised patients. We describe an interesting case of tri-segmental cranial nerve V herpes zoster here with discussion of the salient clinical features as well as brief discussion about ongoing trials for herpes zoster ophthalmicus prophylaxis. This case also highlights the importance of timely treatment and diagnosis, as the patient presented 6 days prior to hospitalization with a mild vesicular facial rash but was lost to follow up without filling a prescription for acyclovir, returning with severe facial involvement.

in nonviral transfection. Lipoplexes in gene therapy offer efficient introduction of a therapeutic material to the living cells. Gemini surfactants also allow introduction of a transgene without inducing natural immunological response and release it inside the cell. In our study, we analyzed the process of complexation of cationic gemini surfactants (3.3 0-[1,6-(2,n-dioxyalcane)] bis(1-dodecyloxyimidazolium dichlorides)) with DNA, using small angle X-ray scattering, circular dichroism spectroscopy and gel electrophoresis. Surfactants which have been used had of variable length of the spacer group. We observed the formation of stable complexes in these systems and the process of complex formation was reproducible, efficient and immediate. The research was supported by research grant