Anaesthetic choice for hip or knee arthroplasty in New Zealand: Risk of postoperative death and variations in use

Anaesthetic choice for large joint surgery can impact postoperative outcomes, including mortality. The extent to which the impact of anaesthetic choice on postoperative mortality varies within patient populations and the extent to which anaesthetic choice is changing over time remain under-explored both internationally and in the diverse New Zealand context. In a national study of 199,211 hip and knee replacement procedures conducted between 2005 and 2017, we compared postoperative mortality among those receiving general, regional or general plus regional anaesthesia. Focusing on unilateral ( n=86,467) and partial ( n=13,889) hip replacements, we assessed whether some groups within the population are more likely to receive general, regional or general plus regional anaesthesia than others, and whether mortality risk varies depending on anaesthetic choice. We also examined temporal changes in anaesthetic choice over time. Those receiving regional alone or general plus regional for unilateral hip replacement appeared at increased risk of 30-day mortality compared to general anaesthesia alone, even after adjusting for differences in terms of age, ethnicity, deprivation, rurality, comorbidity, American Society of Anesthesiologists physical status score and admission type (e.g. general plus regional: adjusted hazard ratio (adj. HR)=1.94, 95% confidence intervals (CI) 1.32 to 2.84). By contrast, we observed lower 30-day mortality among those receiving regional anaesthesia alone compared to general alone for partial hip replacement (adj. HR=0.86, 95% CI 0.75 to 0.97). The latter observation contrasts with declining temporal trends in the use of regional anaesthesia alone for partial hip replacement procedures. However, we recognise that postoperative mortality is one perioperative factor that drives anaesthetic choice.

Review of Extraosseous Applications of Thermal Ablation in the Treatment of Moderate to Severe Large Joint Osteoarthritis

Osteoarthritis (OA) is the most common joint disease worldwide, leading to significant pain, restricted range of motion, and disability. A gap exists between short- and long-term symptom-relieving therapies. Although arthroplasty is an effective treatment for symptomatic end-stage disease, most patients ultimately do not receive a joint replacement due to suboptimal surgical qualifications, comorbidities, or an aversion to surgery. The lack of additional treatment options in this setting makes opioid agonists a commonly used pharmacologic agent, contributing to the addiction epidemic that greatly afflicts our communities. Cooled radiofrequency ablation (CRFA) has arisen as a treatment modality in the setting of moderate to severe OA among patients refractory to conservative management, generally showing greater efficacy compared with other existing strategies. This review focuses on the benefits of CRFA and its technical feasibility as a management option among patients experiencing debilitating large joint OA with limited clinical options.

Magnetic resonance imaging features of large joint tuberculous arthritis

Objectives: Large joint monoarticular tuberculous involvement is rare. It may not be associated with classical clinical features. Hence, it is difficult to differentiate from other conditions similarly involving the large joints. Our study aimed to study the characteristics of large joint monoarthritis on magnetic resonance imaging. Material and Methods: We reviewed the radiology database for large joint tubercular arthritis cases over 2 years. In total, there were 21 patients. Male: female ratio was 11:10. The mean age was 34.14 ± 15.82 years with a range of 8–57 years. We diagnosed tuberculosis (TB) based on histopathological examination or response to antitubercular therapy. Results: Knee was most frequently involved (47%; n = 10) followed by wrist and elbow in 3 patients each (14.28%). Concomitant active pulmonary TB was absent in all of our patients. Grade I synovial thickening was seen in eight patients, Grade II in four, and Grade III in seven. It was uniform in all the cases. Grade 1 bone marrow edema was seen in 06 patients, Grade III in 13, and none in 02. There was soft-tissue edema in 12 patients and soft-tissue collection in 2. Bone erosions were seen in 16 patients with rim enhancement in nine patients. Central erosions were seen in eight, while central and peripheral erosions in eight. On T1-weighted images, the signal intensity was hyperintense 10 and isointense in 11 patients. While on T2-weighted images, it was hyperintense in 10, isointense in nine, and hypointense in two patients. Conclusion: Large joint monoarticular tuberculous arthritis can present variably. Large erosions with rim enhancement, the signal intensity of synovium on T1 weighted and T2 weighted, uniformity of synovial thickening, and enhancement pattern of abscesses can help make a diagnosis.

Correlation of Wells Score, Caprine Score, and Padua Score with Risk of Hypercoagulation Condition Based on D-dimer in Intra-articular, Periarticular, and Degenerative Fracture Patients of Inferior Extremity

BACKGROUND: Surgery for large joint areas can increase risk of venous thromboembolism, which can be in the form of pulmonary embolism or deep vein thrombosis (DVT). As much as, 40–60% of hemostasis abnormalities, specifically hypercoagulable diseases, are suspected of causing this condition. The risk of developing DVT can be assessed using a physiological examination such as Wells score, Caprini score, and Padua score. The scoring systems assess some of the patient’s symptoms and risk factors for increasing the incidence of DVT. Hypercoagulation conditions can be assessed using D-dimer, which is often considered a gold standard in measuring hypercoagulation conditions or as an indicator of DVT. AIM: We aimed to investigate correlation of Wells Score, Caprine Score, and Padua Score with risk of hypercoagulation condition based on d-dimer in intra-articular, periarticular, and degenerative fracture patients of inferior extremity. METHODS: This study used a cross-sectional design and was conducted on 34 participants that undergoing periarticular surgery. This study compared the Wells, Caprini, and Padua scores test against hypercoagulation conditions confirmed by the D-dimer examination. RESULTS: The correlation between Wells, Padua, Caprini scores, and D-dimer was 0.676, 0.023, and 0.395, respectively. CONCLUSION: There was a significant relationship between the Padua scores and the D-dimer.

P084 Recurrent fever in children: why not a mevalonate kinase deficiency?

Background Mevalonate kinase deficiency (MKD) is a rare autosomal recessive auto inflammatory disease. The clinical spectrum of this disease is a continuum ranging from the moderate form of Hyper-IgD syndrome (HIDS) to lethal forms of mevalonic aciduria (MA). An autoinflammatory disease should be considered in children with recurrent fever of unexplained origin. Case report M, 28 months old boy from a non-consanguineous marriage of Algerian parents, presented since the age of two months’ episodes of unexplained fever resistant to antibiotics and requiring several hospitalizations. Family history found that the mother and a maternal uncle experienced an unexplained recurrent fever. Personal history found episodes of fever lasting in average 6 days, with no obvious cause and recurring every 15–20 days; associated with bilateral cervical adenopathy, mouth ulcers, arthralgia, abdominal pain with vomiting and diarrhea. Clinical examination confirmed the fever with temperature of 38.7°, Chills and irritability, Multiple cervical adenopathy oral aphthae, tongue of geographical aspect, cervical pain and large joint arthralgia, tender abdomen with no organomegaly. Biologic workups found major inflammatory syndrome with hyper leucocytosis at 14X103/mm3 predominantly polynuclear, high CRP level, high ESR at 110 mm. Blood cultures and viral serologies were negative. Immunoelectrophoresis found elevated IgA, IgG and IgM with a normal IgD level. Chest X-ray and abdominal ultrasound were normal. The diagnosis of MKD in its moderate form was supported by elevated urinary mevalonic acid excretion to 5.1 mmol/mol during the febrile episode and subsequently confirmed by a 2nd contributory urine assay during another febrile episode. Conclusion MKD is a rare disease. The clinical spectrum of this condition is variable and could benefit of an effective treatment. Our patient developed a moderate form with a better long-term prognosis.

Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: a cluster analysis in the worldwide ASAS-PerSpA study

ObjectiveTo identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist.MethodsCross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.ResultsThe different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist‘s diagnosis as well as with the classification criteria was found.ConclusionThese results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.

O006. Clinical features of paediatric HIV arthropathy

Background Advanced HIV infection is associated with an inflammatory arthritis, however few reports have described this disorder in children. This study aimed to describe the clinical features of HIV arthropathy in a case series of children in South Africa and compare these with features of JIA. Methods Retrospective data were collected from HIV-infected children with HIV arthropathy enrolled in a Paediatric Rheumatology clinic in Cape Town, South Africa. Data from a recently described, published cohort of children with JIA enrolled in the same clinic were included for comparison. Ethical approval was granted by the Human Research Ethics Committee of the University of Cape Town, with a waiver for consent. Results Eleven cases of HIV arthropathy were identified. Cases predominantly affected boys (8/11), and the median age of onset was 10.3 years (IQR 6.9–11.6). Most cases presented in the setting of advanced immunosuppression, with a median absolute CD4+ count of 389 cells/uL (IQR 322–449) and median CD4+ proportion of 19.5% (IQR 14.8–25.0) at presentation. The clinical presentation was variable, with both oligoarthritis (6/11) and polyarthritis (5/11) being prevalent. All cases exhibited large joint involvement, which was usually asymmetrical. In addition, four children had asymmetrical small joint involvement. Associated features included enthesitis (4/11) and dactylitis (1/11). The most consistent laboratory feature was elevated acute phase reactants, and typical ultrasonographic findings were joint effusions and synovial hypertrophy. JIA and HIV arthropathy presented at a similar age, with median age at HIV arthritis onset of 10.3 years (IQR 6.9–11.6) versus 9.25 years (IQR 4.5–12.3) at arthritis onset in the JIA subgroup. HIV arthropathy cases were predominantly male (M/F ratio 3.0), whereas JIA cases had an equal sex distribution (M/F ratio 0.9). Oligo-articular disease was more frequently described in children with HIV arthropathy (55%), compared to those with JIA (38%). Conclusion In this series, most cases of HIV arthropathy exhibited asymmetrical large joint oligoarthritis or polyarthritis, and presented in older boys with advanced immunosuppression. HIV arthropathy appears to present at a similar age to JIA, with a comparable pattern of joint involvement to oligo-articular and poly-articular JIA subtypes.

Fumarolic Pathways Were Structurally Controlled by a Strike-Slip Fault System Beneath the Bishop Tuff, Bishop, California

The Volcanic Tableland, a plateau at the northern end of Owens Valley, CA, is capped by the rhyolitic Bishop Tuff. It hosts many tectonic and volcanic landforms, including hundreds of fault scarps, large joint sets, and inactive fumarolic mounds and ridges. The 1986 Chalfant Valley earthquake sequence shed light on a blind strike-slip fault system beneath the Bishop Tuff. The spatial relationships of the volcanic and tectonic structures have previously been well documented, however, the mechanisms of formation of structures and their enhancement as fumarolic pathways remain largely unexplored. We collected fault kinematic indicators, joint orientations, and documented fumarolic alterations of microcrystalline quartz in the Bishop Tuff and combined those field observations with fault response modeling to assess whether strike-slip activity played a key role in the development of fumarolic pathways. We found field evidence of dip-slip and strike-slip faulting that are consistent with the overall transtensional regional tectonics. Our modeling indicates that a blind strike-slip fault system would dilate joints in the overlying Bishop Tuff with preferred orientations that match observed orientations of joints along which fumarolic activity occurred. Our results imply that the localization of fumaroles was tectonically controlled and that fault activity in the valley floor likely initiated prior to tuff emplacement.

Stretchable, Sensitive, And Environment-Tolerant Ionic Conductive Organohydrogel Reinforced With Cellulose Nanofibers For Human Motion Monitoring

Conductive hydrogel (CH) strain sensors have made significant progress in wearable electronic products in recent years. However, the use of aqueous solvents as the dispersion medium in CHs largely limits the scope of applications of CHs and impedes the combination of the mechanical properties and ionic conductivity, which is urgently desired to be addressed. Herein, a simple one-pot preparation of anti-freezing, anti-drying ionic CHs with high stretchability (up to 869%), toughness (6.60 MJ/m3), and Young's modulus (0.56 MPa) was proposed. These CHs consist of polyvinyl alcohol, tannic acid, and sodium chloride dispersed in a solvent consisting of glycerol and cellulose nanofiber suspension. The thus-synthesized CHs exhibit good ionic conductivity (~ 0.86 S/m) and strain sensitivity (gauge factor of 8.54). The organohydrogel possesses a sensitive strain sensing capability and a wide-working temperature range (-50°C to 60°C), and good stability (30 d in room-temperature) to detect human movement, such as large (joint movement) and subtle movements (voice in the throat). These advantages allow organohydrogel sensors to show great potential for electronic skin, personal healthcare, and flexible wearable devices.

Parameter Optimization of dsRNA Splicing Evolutionary Algorithm Based Fixed-Time Obstacle-Avoidance Trajectory Planning for Space Robot

This paper addresses a smoother fixed-time obstacle-avoidance trajectory planning based on double-stranded ribonucleic acid (dsRNA) splicing evolutionary algorithm for a dual-arm free-floating space robot, the smoothness of large joint angular velocity is improved by 15.61% on average compared with the current trajectory planning strategy based on pose feedback, and the convergence performance is improved by 76.44% compared with the existing optimal trajectory planning strategy without pose feedback. Firstly, according to the idea of pose feedback, a novel trajectory planning strategy with low joint angular velocity input is proposed to make the pose errors of the end-effector and base converge asymptotically within fixed time. Secondly, a novel evolutionary algorithm based on the gene splicing idea of dsRNA virus is proposed to optimize the parameter of the fixed-time error response function and obstacle-avoidance algorithm, which can make joint angular velocity trajectory is planned smooth. In the end, the optimized trajectory planning strategy is applied into the dual-arm space robot system so that the robotic arm can smoothly, fast and accurately complete the tracking task. The proposed novel algorithm achieved 7.56–30.40% comprehensive performance improvement over the benchmark methods, experiment and simulation verify the effectiveness of the proposed method.