The Noisy Ceramic Hip: Is Component Malpositioning the Cause?

Noisy ceramics bearing surfaces are a recently recognized problem in total hip arthroplasty. Component malposition as a potential cause has been proposed. Squeaking occurred in 28 (2.7%) of 999 patients undergoing ceramic on ceramic total hip arthroplasty at our institution. Patients were matched, in a 1:2 ratio by anthropometric and demographic variables and also prosthesis size and type. The acetabular position was measured using radiographs and computed tomography. There was no statistically significant difference in cup inclination (P = .25) or version (P = .38) between groups. Four hips that have been revised were available for retrieval analysis. Stripe wear and metal transfer to ceramic components were observed. Etiology of squeaking ceramic total hip arthroplasty remains elusive. Although malposition could be an important contributing factor, the latter cannot be the sole reason based on our findings. Further investigation to elucidate the etiology is warranted.     

Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?

Background  

Postoperative nausea and vomiting (PONV) is frequent after joint arthroplasty; in addition to causing patient distress, it interferes with early mobilization and hospital discharge. Various antiemetic agents reduce PONV, but their action is limited by a short half-life. Aprepitant, an antiemetic developed for patients receiving chemotherapy, has a duration of action much longer than other antiemetics.     

Host responses are induced in feathers of chickens infected with Marek's disease virus

Control measures are ineffective in curtailing Marek's disease virus (MDV) infection and replication in the feather follicle epithelium (FFE). Therefore, vaccinated birds which subsequently become infected with MDV, shed the virulent virus although they remain protected against disease. The present study investigated host responses generated against MDV infection in the feather. We observed that in parallel with an increase in viral genome load and viral replication in the feather, there was a gradual but progressive increase in infiltration of CD4+ and CD8+ T cells into the feather pulp of MDV-infected chickens, starting on day 4 and peaking by day 10 post-infection. Concomitant with infiltration of T cells, the expression of interleukin (IL)-18, IL-6, interferon (IFN)-gamma and major histocompatibility complex class I genes was significantly enhanced in the feather pulp of MDV-infected chickens. The finding that host responses are generated in the feather may be exploited for developing strategies to control MDV infection in the FFE, thus preventing horizontal virus transmission.     

Total knee arthroplasty following prior distal femoral fracture

Background: Femoral fracture may predispose the knee to the development of post-traumatic arthritis by either a direct intra-articular injury or residual limb malalignment. Malunion, intra-articular osseous defects, limb malalignment, retained internal fixation devices, and compromised surrounding soft tissues may in turn affect the outcome of total knee arthroplasty (TKA) in these patients. The aim of our study was to evaluate the result of TKA in patients with previous distal femoral fracture. Methods: The results of 48 cemented condylar total knee arthroplasties, performed between 1980 to 1998, in 47 patients with a previous distal femoral fracture were reviewed. There were 37 females and 10 males with an average age of 65 years (range, 19–84 years). Follow-up averaged 6.2 years (range, 2–16 years). No patients were lost to follow-up. Results: At the time of arthroplasty a femoral fracture non-union was present in three knees, all of which were treated with a long stem cemented femoral component and bone grafting. Malunion, defined as angulation greater than 10° in the coronal plain or greater than 15° in the sagittal plain, was present in 21 knees. Of these, six underwent distal femoral osteotomy during TKA. In the remaining 15 patients, with a malunion, the deformity was addressed by alterations in the orientation and location of bone resection. Other procedures were commonly needed at the time of arthroplasty and included: lateral retinacular release (22 knees), extensor mechanism realignment (eight knees), and collateral ligament reconstruction (two knees). The mean pre-operative Knee Society Scores were 40 (range, 0–80) for pain and 48 (range, 0–100) for function and improved significantly to a mean of 84 (range, 37–99) and 66 (range, 0–100) points, respectively, at the latest follow-up (P<0.001). The knee arc of motion improved from a pre-operative mean of 83–99° at the latest follow-up (P<0.004). Post-operative manipulation under anesthesia for poor motion was carried out in four knees. Two knees had aseptic loosening that required subsequent revisions. Three knees developed deep infection which was treated with debridement and retention of components in one knee, arthrodesis in another, and eventual amputation in one knee. Conclusions: Significant improvement in function and relief of pain is seen in the vast majority of patients with previous distal femoral fractures undergoing subsequent TKA. However, these patients are at increased risk for restricted motion and perioperative complications following TKA. Special efforts to preserve the vascularity of the skin and subcutaneous tissues, restore limb alignment, ensure correct component positioning, and achieve soft tissue balance may help minimize the problems identified in this study.     

Oral treatment of chickens with lactobacilli influences elicitation of immune responses

Commensal microbes in the intestine are in constant interaction with host cells and play a role in shaping the immune system. Lactobacillus acidophilus, Lactobacillus reuteri, and Lactobacillus salivarius are members of the chicken intestinal microbiota and have been shown to induce different cytokine profiles in mononuclear cells in vitro. The objective of the present study was to examine the effects of these bacteria individually or in combination on the induction of antibody- and cell-mediated immune responses in vivo. The birds received lactobacilli weekly via oral gavage starting on day of hatch and subsequently, at 14 and 21 days, were immunized with sheep red blood cells (SRBC), keyhole limpet hemocyanin (KLH), Newcastle disease virus vaccine, and infectious bursal disease virus vaccine. Antibody responses in serum were measured weekly for 4 weeks beginning on the day of primary immunization. The cell-mediated immune response was evaluated at 21 days postimmunization by measurement of gamma interferon (IFN-γ) production in splenocytes stimulated with inactivated vaccine antigens. L. salivarius-treated birds had significantly more serum antibody to SRBC and KLH than birds that were not treated with probiotics. L. salivarius-treated birds also had decreased cell-mediated immune responses to recall antigen stimulation. L. reuteri treatment did not significantly affect the systemic immune response, while L. acidophilus treatment increased the antibody response to KLH. These results indicate that systemic antibody- and cell-mediated immune responses can be modulated by oral treatment with lactobacilli but that these bacteria may vary in their ability to modulate the immune response.