Total knee arthroplasty is one of the most commonly performed orthopaedic surgical procedures in the United States. Primary concepts in the surgical technique include restoring limb alignment and soft-tissue balance about the knee. Currently, traditional mechanical alignment concepts that focus on restoring neutral limb alignment have been challenged by the principle of kinematic alignment. In addition to these recent philosophical challenges, new technologies have been introduced to help the surgeon more accurately achieve optimal limb alignment and soft-tissue balance.

From this radiographic review, it was observed that not all fractures treated with closed reduction and cast immobilization achieved anatomic position and alignment at final follow-up; however, the long-term clinical and radiographic significance of these findings remains unknown.

This study helps better identify the etiology of failed young patient TKA.

KA plays a role in delaying TKA in knees with meniscal tears and mechanical symptoms with concurrent OA.

INTRODUCTION: Obstructive sleep apnea syndrome (OSA) is a common condition (2-4% of adults) that has been associated with an increased risk of difficult intubation. Two smaller studies (n=15-36) and one larger study (n=90) have estimated the rate of difficult intubation to be 16.7-53% in OSA patients[1-3]. The purpose of this retrospective study was to determine the prevalence of difficult intubation in a large cohort of OSA patients. METHODS: After obtaining IRB approval, OSA patients undergoing surgical procedures were identified by combining a database of polysomnography patients with our surgical booking database (Jan 2003-Dec 2005). Sleep lab charts were reviewed for height, weight, apneahypopnea indices, lowest nocturnal oxygen saturation and self-reported scores of sleep disturbance. Anesthetic records were reviewed for type of surgery and anesthetic method. The lowest oxygen saturation at induction (LSAT) and pertinent airway data were also extracted. Difficult intubation was defined as Cormack-Lehane Grade 3 or 4 direct laryngoscopy, fibreoptic intubation (FOB) or more than 2 intubation attempts by any method[3]. RESULTS: A total of 215 OSA patients (147/68 Male/Female) underwent 297 anesthetic procedures over a 3-year period. Lefort-BSSO surgeries were the most common procedure (11%). The anesthetic and airway techniques employed were: direct laryngoscopy 52.9% (n=157), awake/asleep FOB 6.1% (n=18), Lightwand 6.1% (n=18), Bullard/Glidescope 1.3% (n=4), LMA 11.8% (n=35), spinal/regional 5.1% (n=15), sedation/local 12.5% (n=37) and other 1.0% (n=3). An endotracheal tube was already in-situ for 10 procedures. Table 1 summarizes the airway grades, BMI, and LSAT at induction (mean ± SD). Three patients with Grade 1-2 laryngeal view required 3 laryngoscopic intubation attempts. Based on these results the overall prevalence of difficult intubation was calculated to be 38/197 (19.3%). DISCUSSION: This large retrospective study demonstrates that difficult intubation is common in OSA patients (19.3%). Although the prevalence of difficult intubation in OSA is higher than the general population[4], it is somewhat lower than previously reported[1,2].

Periprosthetic joint infection (PJI) is a devastating complication of total joint arthroplasty (TJA). The rate of PJIs in total hip arthroplasty (THA) procedures varies from 0.3 to 2.9%. Irrigation and debridement (I&D) with modular implant exchange is often performed to treat PJIs. Early management of infection is cited to offer a higher success rate. The goal of this study was to examine the outcomes of early I&D for THA PJIs. We reviewed 38 patients diagnosed with a PJI between 2009 and 2014 who went on to have I&D with modular implant exchange. Patients were separated into three cohorts based on time from index procedure (≤4, 4–8, and ≥8 weeks), and were subsequently linked to treatment success and failure. Success was defined as the eradication of infection and resolution of presenting symptoms. All patients who required additional procedures due to infection were considered failures. Twenty-eight patients (73.7%) were successfully treated while 10 patients (26.3%) required further surgical interventions for persistent infection. Overall, average time between THA and I&D was 44.4 days. Successful I&Ds on average occurred within 41.9 days of the index procedure; while unsuccessful I&Ds were performed 51.6 days after index THA. Additionally, our study demonstrated that obese patients were more likely to fail debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) procedures (p = 0.006). While our results demonstrate that the average time to I&D with a modular exchange was shorter for those who had a successful outcome, the difference was not significant (p = 0.37).