Background Revision total hip arthroplasty (THA), although relieving pain and restoring function, fails in some patients. In contrast to failures in primary THA, the frequency of the causes of failure in revision THA has been less well established. Questions/purposes We therefore determined the rate of each failure mode and the survivorship of revision THAs. Methods We retrospectively reviewed the charts of 1366 revision THAs performed between 2000 and 2007. There were 609 (44.5%) men and 757 (55.5%) women with a mean age of 66 years. The indications for the revision surgery were mainly aseptic loosening (51%), instability (15%), wear (14%), and infection (8%). The minimum followup was 1 day (mean, 5.5 years; range, 1 day to 9 years). Results Two hundred fifty-six of the revisions (18.7%) failed with an average time to failure of 16.6 months (range,

Improving care and treatment for persons infected with hepatitis C virus (HCV) can reduce HCV‐related morbidity and mortality. Our primary objective was to examine the HCV care continuum among patients receiving care at five federally qualified health centers (FQHCs) in Philadelphia, PA, where a testing and linkage to care program had been established. Among the five FQHCs, one served a homeless population, two served public housing residents, one served a majority Hispanic population, and the last, a “test and treat” site, also provided HCV treatment to patients. We analyzed data from electronic health records of patients tested for HCV antibody from 2012 to 2016 and calculated the percentage of patients across nine steps of the HCV care continuum ranging from diagnosis to cure. We further explored factors associated with successful patient navigation through two steps of the continuum using multivariable logistic regression. Of 885 chronically infected patients, 92.2% received their RNA‐positive result, 82.7% were referred to an HCV provider, 69.4% were medically evaluated by the provider, 55.3% underwent liver disease staging, 15.0% initiated treatment, 12.0% completed treatment, 8.7% were assessed for sustained virologic response (SVR), and 8.0% achieved SVR. Regression results revealed that test and treat site patients were significantly more likely to be medically evaluated (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.82‐4.17) and to undergo liver disease staging (aOR, 1.92; 95% CI, 1.02‐2.86) than patients at the other FQHCs combined. Conclusion: In this US urban setting, over two thirds of HCV‐infected patients were linked to care; although treatment uptake was low overall, it was highest at the test and treat site; scaling up treatment services in HCV testing settings will be vital to improve the HCV care continuum.

Porous surfaces are intended to enhance osteointegration of cementless implants. Tantalum has been introduced in an effort to enhance osseointegration potential of uncemented components. We therefore compared the clinical outcome of acetabular components with two different porous surfaces. We retrospectively reviewed 283 patients (295 hips) who underwent cementless revision hip arthroplasty with either an HA-coated titanium cup (207 patients, 214 hips) or porous tantalum cup (79 patients, 81 hips). The minimum followup was 24 months in both groups (titanium: average 51.8 months, range, 24-98 months; tantalum: average, 35.4 months, range, 24-63 months). The titanium and tantalum groups had a mechanical failure rate (clinical plus radiographic) of 8% and 6%, respectively. In hips with minor bone deficiency (type 1, 2A, 2B using the classification of Paprosky et al.), 6% of titanium cups and 4% of tantalum cups failed. In hips with major bone deficiency (type 2C, 3), 24% of titanium cups and 12% of tantalum cups developed failure. In the major bone deficiency group, the tantalum cups had fewer numbers of lucent zones around the cup. Eighty-two percent of titanium cups that failed did so at 6 months postoperatively or later, whereas 80% of tantalum cups that failed did so in less than 6 months. Radiographically in the major group, tantalum cups yielded better fixation.

The treatment of bone loss in revision total knee arthroplasty (TKA) has involved using revision implants in association with cement, augments, particulate, and structural allograft. Newer metaphyseal augments were introduced to allow for metaphyseal fixation of the prosthesis while managing significant bone loss. The purpose of the current study was to evaluate the outcome of revision TKA using metaphyseal sleeves. The authors prospectively followed 96 knees that underwent revision TKA with metaphyseal sleeves. Eighty-three knees met the minimum 2-year criteria for follow-up. Thirty-six sleeves were used in femoral revisions and 83 sleeves were used in tibial revisions. The defects were classified according to the Anderson Orthopaedic Research Institute classification. Femoral defects were classified as type I in 4 knees, type IIb in 25 knees, and type III in 7 knees. Tibial defects were classified as type I in 9 knees, type IIa in 1 knee, type IIb in 68 knees, and type III in 5 knees. The patients were followed for an average of 2.4 years (range, 2.0-3.7 years). Mean Knee Society function score improved from 47.9 to 61.1 points. Mean Short Form 36 physical score improved from 43.3 to 56.3 points. Mean Western Ontario and McMaster Universities Arthritis Index improved from 55.3 to 25.9 points. None of the implants demonstrated progressive radiolucent lines around the metaphyseal sleeves. At final follow-up, only 2 (2.7%) tibial components required revision for aseptic loosening. At short-term follow-up, revision TKA with metaphyseal sleeves provided reliable fixation. This is especially encouraging given the severe nature of bone loss in the majority of patients in whom a metaphyseal sleeve was used. Long-term follow-up is needed to demonstrate the true effectiveness of these devices.

Objective. An estimated 2.7-3.9 million Americans are infected with hepatitis C virus (HCV). Despite being the most common blood-borne virus in the United States, routine HCV testing is not commonly practiced. To address this gap, we measured the impact of integrated routine HCV testing on patient care.Methods. As part of CDC's Hepatitis Testing and Linkage to Care initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites, National Nursing Centers Consortium integrated a routine opt-out HCV testing and linkage-to-care model at five federally qualified health centers in Philadelphia, Pennsylvania, from October 1, 2012, to June 30, 2014. The model included medical assistant-initiated testing, reflex laboratory-based HCV tests, and electronic health record modifications to prompt, track, and facilitate reimbursement for tests performed on uninsured patients.Results. During the study period, 4,207 unique patients received HCV antibody (anti-HCV) testing, of whom 488 (11.6%) tested anti-HCV positive. Of those testing positive, 433 (88.7%) received a confirmatory HCV RNA test; of these 433 recipients, 313 (72.3%) were diagnosed with current infection (overall prevalence 5 7.4%), of which 243 (77.6%) received their HCV RNApositive results, 184 (58.8%) were referred to an HCV care provider, and 121 (38.7%) were linked to care. The highest rates of current infection were among non-Hispanic white patients (18.1%, 90/496); patients from the Public Health Management Corporation Care Clinic, which treats HIV and HCV patients onsite (14.3%, 200/1,394); and patients aged 50-69 years (10.7%, 189/1,767). Conclusion.Our model successfully integrated HCV testing and linkage to care into routine primary care. This study also identified potential successes and barriers that may be experienced by other primary care health centers that are integrating HCV testing.

A majority of US studies on attitudes toward PrEP focus on men who have sex with men with little representation of African Americans. This cross-sectional study seeks to determine openness to PrEP, and examine motivations for openness among Philadelphia residents. Patients undergoing HIV rapid testing between May 2012 and December 2014 in a public setting were administered a survey. Questions included openness to PrEP and reasons for openness to PrEP. Multivariate logistic regression models were used to investigate associations between openness and potential predictors. Analyses were conducted using R version 3.2.4 and the epitools and car packages. Of 5606 respondents, over 90 % were African American. Men were more likely to express openness (61.4 % of men, 54.8 % of women, p < 0.0001). Predictors of openness were younger age, black race, higher perceived risk for HIV by patient or as assessed by Tester, intermittent /no condom use, greater number of partners in 12 months and previous HIV testing. The main reason for openness was fear of HIV, and for disinterest was lack of recognition of risk. Understanding openness to PrEP, and reasons for openness to or disinterest in PrEP are critical to determining the best approaches to facilitate engagement in PrEP care by communities and persons at elevated risk for HIV acquisition. Further study is needed on how best to manage disinterest in PrEP by those at high risk for HIV, and how openness to PrEP translates into concrete steps to take PrEP.

Objective. Despite common risk factors, screening for hepatitis C virus (HCV) and HIV at the same time as part of routine medical care (dual-routine HCV/ HIV testing) is not commonly implemented in the United States. This study examined improvements in feasibility of implementation, screening increase, and linkage to care when a dual-routine HCV/HIV testing model was integrated into routine primary care.Methods. National Nursing Centers Consortium implemented a dual-routine HCV/HIV testing model at four community health centers in Philadelphia, Pennsylvania, on September 1, 2013. Routine HCV and opt-out HIV testing replaced the routine HCV and opt-in HIV testing model through medical assistant-led, laboratory-based testing and electronic medical record modification to prompt, track, report, and facilitate reimbursement for tests performed on uninsured individuals. This study examined testing, seropositivity, and linkage-to-care comparison data for the nine months before (December 1, 2012-August 31, 2013) and after (September 1, 2013-May 31, 2014) implementation of the dual-routine HCV/HIV testing model. Results.A total of 1,526 HCV and 1,731 HIV tests were performed before, and 1,888 HCV and 3,890 HIV tests were performed after dual-routine testing implementation, resulting in a 23.7% increase in HCV tests and a 124.7% increase in HIV tests. A total of 70 currently HCV-infected and four new HIV-seropositive patients vs. 101 HCV-infected and 13 new HIV-seropositive patients were identified during these two periods, representing increases of 44.3% for HCV antibody-positive and RNA-positive tests and 225.0% for HIV-positive tests. Linkage to care increased from 27 currently infected HCVpositive and one HIV-positive patient pre-dual-routine testing to 39 HCVpositive and nine HIV-positive patients post-dual-routine testing.Conclusion. The dual-routine HCV/HIV testing model shows that integrating dual-routine testing in a primary care setting is possible and leads to increased HCV and HIV screening, enhanced seropositivity diagnosis, and improved linkage to care.

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