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Sertoli Leydig cell tumor (SLCT) is a rare sex-cord stromal tumor of the ovary that generally has a benign course. Here, we report an unusual case of recurrent, metastatic SLCT and its unique management with a combination of cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, hyperthermic intrathoracic chemotherapy, and systemic chemotherapy.

Dislocation is a challenging problem after total hip arthroplasty (THA). We sought to evaluate the incidence of early dislocation with 2 different posterior repair techniques after THA using a posterior approach.

From September of 2008 to August of 2019, we evaluated 841 THAs performed by a single surgeon using a posterior approach. Before November of 2015, the capsule was repaired to the greater trochanter (group 1, 605 patients). Starting November 2015, the posterior capsule was repaired in a side-to-side fashion (direct soft-tissue repair) (group 2, 236 patients). There was a mean follow-up of 31.1 months (range, 2.5-122.5 months). A multivariable logistic regression model was constructed to assess the impact of baseline patient and operative factors on the dislocation rate.

There were 22 dislocations, all of which occurred in group 1. There were no dislocations in group 2. After adjusting for patient and operative factors, the direct soft-tissue repair had a large impact on the overall multivariable model as indicated by its effect likelihood ratio of 10.33 (

= .001); however, the odds ratio was not calculable for this factor, given that there were no dislocations in hips with direct soft-tissue repair. Increasing age was associated with an increased odds of dislocation (odds ratio, 1.04,

= .017), with an effect likelihood ratio of 6.25 (

= .012).

Switching from a capsular repair to the greater trochanter to a side-to-side capsular repair was associated with a decreased rate of dislocation in primary THA through a posterior approach.

Switching from a capsular repair to the greater trochanter to a side-to-side capsular repair was associated with a decreased rate of dislocation in primary THA through a posterior approach.

Outpatient total knee arthroplasty (TKA) is becoming more commonplace in the United States. Alternatively, the current practice in the Middle East involves an inpatient stay of 7-10 days in the hospital after TKA. This study reports the early results of the first reported series of outpatient TKA performed on patients in the Middle East and compares the clinical and functional outcomes with those of patients who underwent inpatient TKA.

Eighty-eight patients underwent TKA (inpatient 44 and outpatient 44) using the modified intervastus approach in 2 hospitals in the Middle East from 2017 to 2019. Clinical and functional outcomes were assessed by recording the Knee Injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, and knee range of motion (ROM) preoperatively, on the day of surgery, and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months.

Two patients undergoing outpatient TKA had complications one patient suffered a periprosthetic fracture on postoperative day 10 after een in this study, which we believe are unrelated to the patient's discharge status. The concept of outpatient TKA using the modified intervastus approach was very well accepted by the patients in this study and can potentially be applied safely elsewhere in the region.Despite its popularity, the direct anterior approach for hip arthroplasty is not without complications. Intraoperative femoral shaft perforation using this approach ranges from 0.8% to 7%. A missed perforation can lead to fracture with the need for further surgery if not detected intraoperatively. We describe a reproducible and cost-effective technique using a plastic Yankauer suction handle to help identify proximal femoral perforations during direct anterior total hip arthroplasty. Careful attention to the visual, tactile, and auditory feedback provided by the suction handle can help ensure the cortical continuity of the proximal femur. Familiarity with relevant surgical anatomy, improving surgical technique, and scrutinizing implant positioning helps minimize the risk of complications during the direct anterior approach.

Despite an increasing incidence and associated morbidity, the optimal timing for the surgical management of periprosthetic hip fractures remains unknown. This study sought to explore whether time to surgery was associated with medical or surgical complications.

A retrospective review of Medicare data from 2010 to 2014 was performed using PearlDiver. All patients with a periprosthetic hip fracture greater than 90 days from surgery and undergoing open reduction internal fixation (ORIF) or revision total hip arthroplasty (RTHA) were included. Time to surgery was measured from diagnosis and dichotomized at 48 hours.

Of 342 patients undergoing ORIF, 269 (79%) had surgery within 48 hours. find more Of 255 patients undergoing RTHA, 142 (56%) had surgery within 48 hours. For ORIF, surgery more than 48 hours afterdiagnosis was associated with an increased rate of 30-day deep vein thrombosis or pulmonary embolism (15% vs 7%,

= .03), which remained after adjustment (odds ratio [OR] 2.71, 95% confidence interval [CI] 1.11-6.45). A similar association was seen for RTHA (12% vs 6%,

= .09 and OR 2.61, 95% CI 1.01-7.24). For RTHA, surgery more than 48 hours after diagnosis was associated with an increased rate of 90-day periprosthetic joint infection (12% vs 4%,

= .007), which remained after adjustment (OR 3.86, 95% CI 1.36-12.72). A similar but not significant association was seen for ORIF (7% vs 3%,

= .18 and OR 2.65, 95% CI 0.73-8.91).

Among Medicare patients with a periprosthetic hip fracture, time to surgery greater than 48 hours was associated with increased medical and surgical complications.

Among Medicare patients with a periprosthetic hip fracture, time to surgery greater than 48 hours was associated with increased medical and surgical complications.

Variables considered by hip and knee arthroplasty fellowship program directors (PDs) to select fellowship candidates are not well known.

A web-based questionnaire containing 5 questions was developed and sent to all 92 adult reconstruction fellowship PDs via email. Three questions collected program information including the number of positions available, the number of candidates interviewed, and ranked annually. PDs were then given a list of 12 factors and asked to rank them in the order of importance. A weighted score for each factor was calculated using the following scale 5 points each time a factor was ranked 1st, 4 points each time a factor was ranked 2nd, 3 points for each 3rd place rank, 2 points for each 4th place rank, and 1 point for each 5th place rank. PDs were also allowed to write in other factors they considered important when ranking fellowship candidates.

The overall response rate was 34.8% (32/92). link2 Seventy-five percent of responding programs indicated that they interview between 21 and 40 applicants per year for their fellowship position(s). The interview was ranked as the most important variable in selecting applicants by 53.1% of responding PDs, followed by letters of recommendation (ranked first by 25% of PDs) and personal connections to the applicant and/or letter writer(s) (ranked first by 9% of PDs). A positive correlation was identified between the program size and an applicant's geographical ties to the city/town of the fellowship program (



= 0.472;

= .006).

According to hip and knee arthroplasty fellowship PDs, the interview, letters of recommendation, and personal connections to the applicant and/or letter writers are the most important factors considered in selecting arthroplasty fellowship candidates.

According to hip and knee arthroplasty fellowship PDs, the interview, letters of recommendation, and personal connections to the applicant and/or letter writers are the most important factors considered in selecting arthroplasty fellowship candidates.Hypersensitivity reactions to zirconia (ZrO2) or similar ceramics is highly unusual. Owing to the stable oxide formed between the base metal and oxygen, ceramics are considered relatively biologically inert. link3 We report the case of an otherwise healthy 50-year-old woman with a 5-year history of progressively worsening right hip pain who underwent a ceramic-on-polyethylene total hip replacement and subsequently developed hypersensitivity reaction. After metal allergy testing showed her to be highly reactive to zirconium, the femoral head was revised to a custom titanium implant and her symptoms resolved.

The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program to compare the perioperative and postoperative outcomes after total hip arthroplasty (THA) for DDH and primary OA via a propensity-matched pair analysis and the valuation of THA between both groups.

All patients who underwent THA between 2008 and 2016 were identified from National Surgical Quality Improvement Program database via the current procedural terminology (CPT) code. Patients were further identified and stratified based on International Statistical Classification of Diseases and Related Health Problems-9/International Statistical Classification of Diseases and Related Health Problems-10 diagnosis codes for primary OA (n= 115,166) and DDH (n= 603), which included codes for congenital hip dislocation, hip dysplasia, or juvenile osteochondrosis. Demographic variables were used to create 557 propensity-matched pairs.

The DDH group was associated with a significantly longer operative tved associations are likely an underestimate of the true risk posed to patients with severe DDH, as these patients were unable to be stratified in the present analysis.

Limited literature exists concerning the femoral cement mantle quality that can be achieved through an anterior approach in total hip arthroplasty (THA). We radiologically evaluated the quality and thickness of the femoral cement mantle in patients undergoing THA utilizing the direct anterior approach (DAA).

Immediate postoperative anteroposterior and lateral radiographs of 116 consecutive patients who underwent hybrid or fully cemented THA using the DAA and cemented Quadra-C stem (Medacta, International, SA, Switzerland) were assessed by 2 arthroplasty surgeons blinded to the study. Surgical indications were hip osteoarthritis or subcapital hip fracture. The cement mantle and stem alignment were evaluated using the Barrack classification and Khalily methods, respectively. After calibration of radiographs, the thinnest part of the cement mantle per Gruen zone was recorded. Parameters were compared between obese and nonobese patients.

Agreement between raters was substantial for the cement quality in anteroposterior (k= 0.707,

≤ .001) and moderate for lateral radiographs (k= 0.574,

≤ 001). The cement mantle was graded A in 39.25%, B in 53.0%, and C in 7.75% of anteroposterior radiographs and similarly for lateral radiographs (40.1% A, 51.75% B, 9.5% C). 93% of stems had neutral alignment. The mean thinnest cement mantle (

= .237) and incidence of inadequate cement mantle (<2 mm) per zone (

= .431) were comparable between Gruen zones. The cement mantle quality (

= .174) and inadequacy (

> .05) and stem alignment (

= .652) were comparable between obese and nonobese patients.

DAA enables correct implantation and effective cementation of straight femoral stems. A high-quality cement mantle can be achieved using DAA even in obese patients.

DAA enables correct implantation and effective cementation of straight femoral stems. A high-quality cement mantle can be achieved using DAA even in obese patients.