To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for the treatment of chronic inflammatory joint pain via systematic review and meta-analysis.

MEDLINE and EMBASE databases were searched for studies reporting outcomes in patients with chronic inflammatory joint pain treated with TAE. Meta-analyses of pain score changes, changes in proportions of patients on analgesic medications, range of motion changes, technical success rates, and adverse events rates were performed. Subgroup analyses were conducted with respect to pain site (knee versus shoulder).

Fourteen observational studies, which included 346 patients, were reviewed. The pooled technical success rate was 95.8%, and no major adverse events were observed. The pooled mean difference in pain score at 1 week was 3.1. At 1, 3, and 6 months, the difference in score was 4.0, 4.2, and 5.1, respectively. At 1 year, the difference was 5.5. Subgroup analysis demonstrated that shoulder embolization was associated with greater reduction of pain than knee embolization at 3 and 6 months (P < .001 and P= .018, respectively), whereas there was no significant difference between the sites at 1 month (P= .734). The pooled proportions of patients on analgesic medication at baseline and at 1, 3, 6, and 12 months were 81.1%, 36.3%, 42.3%, 28.2%, and 22.4%, respectively. The pooled estimated increase in the range of motion among patients who underwent shoulder embolization was 55.6° for anterior elevation and 64.7° for abduction.

TAE is an effective and safe therapeutic option for patients with chronic inflammatory joint pain.

TAE is an effective and safe therapeutic option for patients with chronic inflammatory joint pain.Empedobacter falsenii is an emerging opportunistic pathogen that has been occasionally implicated in various human infections. In this study, we described the genomic features of a multidrug resistant E. falsenii Q1655 obtained from a patient attending a public hospital in Sokoto, northwest Nigeria. The isolate, E. falsenii Q1655, was isolated from the stool sample of a patient in Sokoto, Nigeria. The identity of the isolate was confirmed by MALDITOF-MS. The disc diffusion test and modified Carba-NP test were used for phenotypic antibiotic susceptibility test and carbapenemase enzyme production test, respectively. The whole genome of the strain was sequenced using the Illumina MiSeq technique. Resistome analysis was done by annotation of the WGS against the ARG-ANNOT database. The isolate was resistant to all β-lactam antibiotics with the exception of cefepime. The MICs of imipenem and ertapenem as determined by E-test were 12 μg/ml and 2 μg/ml, respectively. Modified Carba NP test showed that the strain was carbapenemase producing. Resistome analysis revealed the presence of a novel metallo-β-lactamase, a chromosomal blaEBR-4, which exhibited 94.92% and 97.02% nucleotide and protein sequence identities respectively with blaEBR-3 gene of E. falsenii 174,820. Seven and eight amino-acid substitutions were observed with the blaEBR-1 and blaEBR-2, respectively. We reported the first isolation and genomic description of an extensively drug resistant isolate of Empedobacter falsenii in Nigeria. This report broadens our knowledge of carbapenem resistance in E. falsenii and it will serve as a useful guide in the development of antibiotic use policy.

No consensus exists regarding the appropriate timing of bariatric surgery (BS) or the complication profiles between Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy (SG) prior to total knee arthroplasty (TKA). We sought to compare 90-day medical and up to two-year surgical complications and revisions among (1) BS performed 6 months and 1 year prior to TKA; (2) between BS types (RYGB and SG) prior to TKA; and (3) with comparison to 2 non-BS cohorts of morbidly and nonmorbidly obese patients.

We queried a national database to identify patients undergoing BS (RYGB and SG) prior to TKA from 2010 to 2020. Timing (six-month and one-year intervals) and type of BS (RYGB and SG) were identified. Cohorts without prior BS served as comparators BMI, kg/m

> 40 and 20-35. Ninety-day to two-year medical/surgical complications and revisions were assessed. Multivariate regression analyses examined the risk factors for prosthetic joint infections (PJIs) and revisions.

The timing of BS (6 months and 1 year) had similar incidences of medical/surgical complications and revisions, with both lower than the BMI > 40 cohort (P < .001). Differences between types of BS were also lower than the BMI > 40 cohort (P < .001). The BMI 20-35 had lower complications and revisions among all cohorts. No differences were observed between BS timing or type as risk-factors for PJIs and revisions.

Timing (6 months or 1 year prior to TKA) and type of BS shared similar complication profiles, lower than BMI > 40 and higher than BMI 20-35. These findings support a surgeon’s decision to proceed with TKA at six months post-BS if indicated.

40 and higher than BMI 20-35. These findings support a surgeon’s decision to proceed with TKA at six months post-BS if indicated.

One of the most undesirable results after total knee arthroplasty (TKA) is severe immediate postoperative pain, resulting in patient dissatisfaction. We aimed to evaluate nefopam’s analgesic efficacy after primary TKA along with related outcomes, including morphine consumption and adverse events.

We conducted a double-blind, randomized controlled trial of patients undergoing unilateral primary TKA, comparing 24hours of 80 mg of continuous intravenous nefopam to placebo infusion. A 100-mm Visual Analog Scale (VAS) for pain-at-rest and in-motion ≤48hours was the primary outcome measure. Secondary outcomes were morphine and antiemetic consumption, adverse events, and functional outcomes time-to-walk, timed up-and-go test, postoperative knee range of motion at 24 and 48hours, time-to-discharge, and patient satisfaction scores.

Patients in the nefopam group had significantly lower VAS at rest 6hours postop (20.3±27.3 vs 35±24.3, P= .01). Other timepoints and in-motion VAS did not significantly differ. Total morphine consumption (0-48hours) was 37% less, significantly lower, in the nefopam group (5.3±4.5 vs 8.4±7.5 mg, P= .03). Antiemetic consumption was also 61% lower in the nefopam group but not statistically significant (0.8±2.3 vs 2.0±3.8 mg, P= .08). There were no variations in adverse events, functional outcomes, and satisfaction scores between groups.

Continuous nefopam administration as part of multimodal analgesia for 24hours post-TKA produced a significant analgesic effect but only within the first 6hours. However, there was a notable reduction in morphine use 48hours postop. Nefopam is a useful agent for contemporary pain control after TKA.

Therapeutic Level I.

Therapeutic Level I.

This study aimed to establish a new classification using locked-plate fixation for periprosthetic distal femoral fracture (PDFF) following total knee arthroplasty (TKA) and to determine when dual locked-plate fixation is necessary through defining this classification.

One-hundred fifteen consecutive PDFFs that underwent operative treatment were reviewed from 2011 to 2019 with minimum 1-year follow-up. Most PDFFs were fixed with single or dual locked-plate fixations using the minimally invasive plate osteosynthesis technique. Based on preoperative radiographs, PDFFs were classified according to the level of main fracture line relative to the anterior flange of femoral component type I and II, main fracture line located proximal and distal to the anterior flange; and type III, component instability regardless of fracture line requiring revisional TKA. Furthermore, type II fractures were subclassified based on the direction of fracture beak as follows type II

, lateral-beak; type II

, medial-beak. The incie, dual plate fixation is necessary to prevent fixation failure or nonunion.

Preserving bone stock in younger and more active patients after total hip arthroplasty (THA) is important for future revision. Newer prosthesis designs, including short femoral stems and isoelastic acetabular cups, are likely to preserve more bone stock. However, long-term follow-up studies on bone remodeling after short-stem THA with an isoelastic monoblock acetabular cup are few. Therefore, we evaluated bone preservation after THA using these prostheses at a 5-year follow-up.

This prospective observational study is a 5-year follow-up of our previously reported 2-year observational study on the same cohort of patients. We included 45 patients with primary osteoarthritis treated with a calcar-guided femoral short-stem prosthesis and a monoblock press-fit acetabular cup. We evaluated bone mineral density (BMD) around the prostheses using dual-energy X-ray absorptiometry and reported functional outcomes preoperatively and at 3, 12, 24, and 60 months postoperatively. All complications were recorded.

At the final follow-up, the BMD was comparable with that at 24 months in Gruen zones 3, 4, 5, 6, and 7, whereas it significantly differed in Gruen zones 1 (P < .0001) and 2 (P < .004). On the acetabular side, the BMD leveled off similarly in all DeLee and Charnley zones between 24 and 60 months (P > .05). Moreover, all measured clinical outcomes significantly improved (P < .001). One perioperative dislocation was reported.

Patients undergoing THA with a calcar-guided femoral short-stem prosthesis and a monoblock acetabular cup can expect preservation of bone stock over a longer follow-up with excellent clinical outcomes and few complications.

Patients undergoing THA with a calcar-guided femoral short-stem prosthesis and a monoblock acetabular cup can expect preservation of bone stock over a longer follow-up with excellent clinical outcomes and few complications.

Lateral unicompartmental knee arthroplasty (UKA) is a viable solution for isolated lateral compartment arthritis. Several prosthetic designs are available such as fixed-bearing metal-backed (FB M-B), fixed-bearing all-polyethylene (FB A-P), and mobile-bearing metal-backed (MB M-B) implants. The purpose of this meta-analysis is to compare failure rates of different prosthetic designs.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review was conducted using 4 databases (MEDLINE, EMBASE, Cochrane, and PubMed) to identify all studies that investigate outcomes of lateral UKA. Twenty-one studies met the inclusion criteria, and failure rates were compared by implant type and follow-up time separately in order to assess potential confounding factors. Two separate analyses have been performed among different implant designs (FB M-B vs FB A-P vs MB M-B) and different follow-ups (<5 years, between 5 and 10 years, >10 years).

The failure rate of FB M-B lateral UKA was significantly lower compared to other lateral UKA designs present in the market (0.8% vs 8.6% and 7.1% for FB M-B, FB A-P, and MB M-B, respectively). No significative difference among groups has been detected when comparing all implants with regard to follow-up time.

Considering actual evidence, for a surgeon approaching lateral UKA, the FB M-B design is preferable, given the lower failure rates and subsequently a longer implant survivorship.

Considering actual evidence, for a surgeon approaching lateral UKA, the FB M-B design is preferable, given the lower failure rates and subsequently a longer implant survivorship.