Perceptions of the difficulty and outcome of unicompartmental knee arthroplasty revision (rev-UKA) vary. We analyzed differences in the complexity, cost, and survival of rev-UKAs compared with revision TKAs (rev-TKA). One hundred eighty knee arthroplasty revisions (68 rev-UKAs/112 rev-TKAs), defined as a minimum of tibial or femoral component revision, were identified from a community joint registry of 7587 knee implants performed between 1991 and 2005. Four of 68 rev-UKAs (5.9%) were revised a second time, whereas seven of 112 rev-TKAs (6.3%) were rerevised. Rev-TKA was predictably more complex than rev-UKA based on the proxies of operative time, use of modular augmentation and stems, and polyethylene liner thickness. Thirty-nine of 68 rev-UKAs (57%) had no form of augmentation and were revised as primary TKAs. There were more rev-TKAs than rev-UKAs with an implant cost greater than $5200 (42% versus 12%) and hospital charges greater than $33,000 (48% versus 25%). We found no difference in survival between the groups. Although rev-UKAs had less surgical complexity and bone loss at the time of revision compared with rev-TKAs, we were unable to show improved survival of rev-UKAs compared with rev-TKAs. Rev-UKAs were associated with lower implant costs and hospital charges compared with rev-TKAs.
Serotonin (5-HT) plays important regulatory roles in mammalian circadian timekeeping; however, little is known concerning the regulation of serotonergic activity in the circadian clock located in the suprachiasmatic nuclei (SCN). By using in vivo microdialysis to measure 5-HT release we demonstrated that electrical or pharmacological stimulations of the dorsal or median raphe nuclei (DRN and MRN, respectively) can alter basal release of 5-HT in the hamster SCN. There were similar increases in SCN 5-HT release after electrical stimulation of either the MRN or DRN, indicating that both could contribute to the serotonergic activity in the SCN. Systemic pretreatment with the 5-HT antagonist metergoline abolished DRN-induced SCN 5-HT release but had little effect on MRN-induced SCN 5-HT release, suggesting different pathways for these nuclei in regulating 5-HT output in the SCN. Microinjections of the 5-HT1A autoreceptor agonist 8-OH-DPAT or antagonist WAY 100635 into the MRN caused significant inhibition and stimulation of SCN 5-HT release, respectively. Both drugs had substantially less effect in the DRN. These differential drug actions indicate that somatodendritic 5-HT1A autoreceptors on MRN neurons provide the prominent raphe autoregulation of 5-HT output in the SCN. Collectively the current results are evidence that DRN as well as MRN neurons can contribute to the regulation of 5-HT release in the hamster SCN. On the basis of the current observations and those from recent anatomic tracing studies of serotonergic projections to SCN it is hypothesized that DRN input to the SCN could be mediated by a DRN --> MRN --> SCN pathway involving a 5-HT-sensitive multisynaptic interaction between the DRN and MRN neurons.
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