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Hydrolyzed feather meal (HFM) is a feed that is high in rumen undegradable protein; however, it is low in Lys compared with other high rumen undegradable protein sources. Additionally, processing methods differ by facility, which affects AA composition and protein digestibility. The objective of this study was to use lactating dairy cows to determine the effects of feeding 2 sources of HFM that differed by the amount of blood they contained and also to study the effects of supplementing rumen-protected (RP) Lys when these sources of HFM are fed. In this study, 12 multiparous Jersey cows were enrolled in a triplicated 4 × 4 Latin square with 4 periods 28 d in length. Cows were fed 2 total mixed rations that differed by source of HFM. The HFM was included at 4.5% of the diet dry matter, and one source was produced with the addition of poultry blood. Cows were randomly assigned to 1 of 4 treatment sequences. Treatments were as follows HFM without added blood and no RP-Lys, HFM with added blood and no RP-Lys, HFMbe a factor that affects milk production and that this in part is due to differences in the profile of AA. Additionally, the observation that plasma His and milk protein increased with the consumption of HFM containing more blood suggests that His may have played a role in increasing milk and milk protein yield.

The UK National Joint Registry is the single largest joint registry in the world enrolling 1.3 million patients and recently reaching 17 years of follow-up data. Current knee prosthesis longevity estimates are based off smaller sized international registries and the impact of fixation type on prosthesis survival remains unclear.

We used the UK National Joint Registry 17th annual report to calculate pooled mean survival estimates of total knee replacements (TKRs), unicondylar knee replacements (UKRs), and patellofemoral knee replacements at 10 and 15 years based on both construct brand and fixation technique (cemented vs uncemented). Independent t-testing was performed for significance.

All-cause survivorship of TKRs at 10 and 15 years is 96.7% and 95.4%, respectively. CPT inhibitor For UKRs it is 89.8% and 80.7% and for patellofemoral knee replacements it is 81.6% and 76.5%. In regard to fixation technique, cemented and uncemented TKRs show similar survivorship at both time points. For UKRs uncemented constructs showed improved survivorship compared to cemented at 10 years (92.7% vs 88.2%, P < .001). This was greatest among those <65 years of age. In fact, all construct types regardless of fixation showed increased rate of revision in those <65 years vs those ≥65 years.

We provide more accurate estimations for knee prosthesis survival and highlight that younger patients, particularly those receiving UKRs, are prone to greater revision risks. This data also suggests that uncemented fixation may offer improved joint survival in these patients.

We provide more accurate estimations for knee prosthesis survival and highlight that younger patients, particularly those receiving UKRs, are prone to greater revision risks. This data also suggests that uncemented fixation may offer improved joint survival in these patients.

Patient-specific instrumentation (PSI) has been introduced in total knee arthroplasty (TKA) with the goal of increased accuracy of component positioning by custom fitting cutting guides to the patient's bony anatomy. A criticism of this technology is the associated cost. The purpose of this randomized controlled trial was to determine the cost-utility of PSI compared with standard of care (SOC) instrumentation for TKA in an obese population.

Patients with body mass index greater than 30 with osteoarthritis and undergoing primary TKA were randomized to SOC or PSI. Patients completed a health care resource use diary and the EuroQol-5D at three, six, nine, and 12 months and the Western Ontario and McMaster Universities Osteoarthritis Index at three and 12 months postsurgery. We performed cost-utility and cost-effectiveness analyses from public health care payer and societal perspectives.

One hundred seventy-three patients were included in the analysis with 86 patients randomized to PSI and 87 to SOC. PSI was dominated (more costly and less effective) by SOC from a health care payer perspective. From a societal perspective, an incremental cost-utility ratio was calculated at $11,230.00 per quality-adjusted life year gained, which is cost-effective at a willingness to pay threshold of $50,000. Net benefit analyses found PSI was not significantly cost-effective at any willingness to pay value from either perspective.

Our results suggest that widespread adoption of PSI may not be economically attractive or clinically indicated. Future considerations are to compare long-term clinical outcomes and radiographic alignment between the groups.

Our results suggest that widespread adoption of PSI may not be economically attractive or clinically indicated. Future considerations are to compare long-term clinical outcomes and radiographic alignment between the groups.

Excessive posterior tibial slope in medial unicompartmental knee arthroplasty (UKA) has been implicated in early failure. The purpose of this study was to evaluate the relationship between preoperative posterior tibial slope and postoperative slope of the implant (PSI) on outcomes in patients with anterior cruciate ligament (ACL) intact and ACL-deficient knees after fixed-bearing medial UKA.

Patients who underwent a medial UKA between 2002 and 2017 with a minimum 3-year follow-up were included. Preoperative posterior tibial slope and postoperative PSI were measured. Outcomes measures included Knee Injury and Osteoarthritis Outcomes Score (KOOS) subscales, Lysholm, and VR-12. Failure was defined as conversion to total knee arthroplasty.

Of 241 knees undergoing UKA, 131 patients (70 women, 61 men; average age of 65 ± 10 years (average BMI of 27.9 ± 4) were included. For all patients, survivorship was 98% at 5 years and 96% at 10 years with a mean survival time for UKA was 15.2 years [95% CI 14.6-15.7]. No UKA had a 96% survivorship at 10 years.

Self-reported penicillin allergies in patients undergoing total joint arthroplasty often results in the use of second-line prophylactic antibiotics. A higher risk of prosthetic joint infection (PJI) is associated with suboptimal antibiotics vs first generation cephalosporins, which have historically been grouped with other beta-lactam antibiotics such as penicillin for potential allergic reactions. This study evaluates the economic burden of self-reported penicillin allergies in total joint arthroplasty (TJA).

Data from studies reporting true incidence of IgE-mediated penicillin allergies, infection-free survivorship of TJA, and cost of PJI attributed to use of second-line antibiotics were obtained. Projected cost of preoperative penicillin allergy testing and potentially avoidable PJI associated with second-line antibiotic usage were calculated. This was compared with projected cost of PJI in the current state to estimate cost savings.

Implementation of preoperative penicillin allergy testing leads to a potential savings of nearly $37 million to payors in the first year based on 1-year survivorship.