Joint Replacement Institute

Abstract. Robust estimates of methane emissions are critical for understanding their impacts on atmospheric warming and air quality, and for assessing methane mitigation strategies. Gridded inventories, such as the U.S. Environmental Protection Agency’s Greenhouse Gas Inventory (EPA GHGI), the Emissions Database for Global Atmospheric Research (EDGAR 2024), and the National Oceanic and Atmospheric Administration’s Fossil Fuel Oil and Gas inventory (NOAA FOG), are constructed to evaluate large-scale emission patterns and support identifying emission mitigation priorities and prioritizing future measurements. However, substantial differences across inventories complicate such assessments. We benchmark EPA GHGI, EDGAR 2024, and NOAA FOG against flux estimates from an atmospheric inversion of Greenhouse Gases Observing Satellite (GOSAT) data from 2012 to 2020 over the Contiguous United States (CONUS). A key technical challenge is the heterogeneous sensitivity of satellite-derived fluxes, which depends on measurement uncertainty, coverage, and inversion model configuration. We account for this heterogeneity by applying an inversion operator to each inventory prior to comparison with the GOSAT-based estimates. The GOSAT estimates are most sensitive to oil&gas and livestock emissions; oil and gas emissions are consistent with NOAA FOG (14.1 Tg CH4 yr⁻¹ in 2015), but exceed EPA GHGI and EDGAR, particularly across Texas, Oklahoma, and Louisiana. GOSAT-based livestock emissions exceed EPA GHGI and EDGAR by 1–2 Tg CH4 yr⁻¹, with the largest differences in the Midwest and California. Despite these discrepancies, both activity and satellite based estimates show no observable trends from 2012 to 2020 in fossil and livestock emissions.

Evidence on the outcome of aseptic exchange of rotating-hinge prosthesis is missing in the literature. This study aimed to evaluate implant survival, complication rates, and clinical outcomes following revision of a rotating-hinge prosthesis to another rotating-hinge prosthesis with anatomical axis. Between March 2014 and Juli 2023 62 cases of aseptic exchange of a rotating-hinge prosthesis were performed at a tertiary medical center in Germany. In this retrospective study, all patients were contacted for clinical follow-up and prosthesis survival. Implant survival was analyzed using the Kaplan-Meier method, and clinical outcomes were assessed using the Knee Society Score. The 5-year implant survival rate was 83.4% (73.2-93.6, 95%-CI) for revision due to any reason, 85.1% (75.3-94.9, 95%-CI) for aseptic failure and 98.0% (94.1-100.0, 95%-CI: ) for septic failure. The estimated 10-year survival rates were 73.2% (59.2-87.1%; 95%-CI), 78.0% (65.1-90.9%; 95%-CI), and 93.9% (85.3-100.0%; 95%-CI), respectively. Improvements were observed in all KSS subdomains except for the Patient Expectation Score. The exchange of a rotating-hinge prosthesis, using metaphyseal cones when indicated for bone defects, yields implant survival and complication rates comparable to those of primary rotating-hinge prosthesis implantation. However, clinical outcome scores tend to be lower than those reported for first-time implantation of rotating-hinge prostheses.

BackgroundIn simultaneous bilateral total knee arthroplasty (bTKA), surgeons often encounter scenarios where femoral or tibial component sizes differ between limbs. While component sizing is routinely individualized, the functional and survivorship implications of such asymmetry remain insufficiently studied. A clearer understanding is clinically relevant, as patient anatomy, bone stock, and soft-tissue balance often necessitate asymmetric sizing, yet evidence guiding its safety and outcomes is limited. This prospective multicenter study evaluated whether inter-limb differences in component sizing influence postoperative function, patient-reported outcomes, or revision risk in bTKA.MethodsPatients undergoing cemented bTKA with standardized implants (metal femoral components, metal-backed tibial baseplates, and ultra-high-molecular-weight polyethylene inserts) were prospectively enrolled across 10 high-volume centers. Patients were stratified into Subset A (identical component sizes in both knees) and Subset B (different component sizes between knees). Clinical and functional outcomes were assessed preoperatively and postoperatively at regular intervals up to three years. Endpoints included range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short-Form Health Survey (SF-36). Radiographic assessment evaluated alignment, fixation, and implant stability. Minimal clinically important difference (MCID) thresholds were used to confirm the clinical relevance of improvements.ResultsA total of 166 patients (332 knees) were analyzed, with 140 in Subset A and 26 in Subset B. Baseline characteristics were comparable between groups. Both subsets demonstrated significant improvements in ROM and functional scores from baseline to three years (p<0.001 for within-group changes). Subset A achieved higher final ROM (123.6° vs. 118.1°; p<0.001) with less variability, and KSS were also significantly greater in this group (p<0.05).Subset B, despite inter-knee size differences, showed improvements similar to Subset A in WOMAC scores and demonstrated higher values in selected SF-36 domains, including physical functioning, role limitations, and emotional well-being (p<0.05). No implant-related complications, revisions, or radiographic failures were reported in either group during the three-year follow-up, and radiographs confirmed stable and well-aligned prostheses.ConclusionA one-size difference in femoral or tibial components between knees does not compromise clinical or functional outcomes in bTKA. While symmetric sizing may provide slightly greater ROM and KSS improvements, minor asymmetry is not detrimental and may even be associated with enhanced patient-reported quality-of-life domains. These findings support the practice of individualized component selection and reassure surgeons that small inter-limb differences in implant sizing do not negatively impact mid-term function or survivorship.

<strong class="journal-contentHeaderColor">Abstract.</strong> Multi-hazard events pose increasingly complex challenges to societies worldwide, as natural hazards interact in cascading and compounding ways that amplify risks beyond individual hazards. Understanding these complex interactions is critical for effective disaster risk management, preparedness, and response strategies. National and international frameworks have increasingly recognised these risk dynamics, most notably the Sendai Framework for Disaster Risk Reduction 2015&ndash;2030. With the Sendai Framework approaching its conclusion, there is a pressing need to address current shortcomings and contribute meaningfully to shaping the next generation of global disaster risk reduction (DRR) frameworks. Acknowledging this need, the 3rd International Conference on Natural Hazards and Risks in a Changing World took place on June 12&ndash;13, 2024, with the objective of strengthening the integration of multi-hazard risk into scientific research and policy practice in support of the Sendai Framework for Disaster Risk Reduction. Here, we document the arc of the scientific discussions held at the conference, synthesise the main findings from sessions, and set forth expert knowledge on how state-of-the-art science can fill gaps outlined by the Sendai Framework Mid Term Review by identifying four perspective themes: (1) assessments and tools for risk understanding and decision-making; (2) complex risk landscapes; (3) emerging technologies for risk and resilience; and (4) multi-level governance for coordinated risk management. Ultimately, there was a strong call from the conference for moving beyond siloed thinking toward greater integration of multi-hazards, vulnerability dynamics, multi-level governance, stakeholder engagement, and scientific disciplines across spatial and temporal dimensions, while recognising that the challenge ahead lies in finding the optimal balance between sufficient integration and manageable complexity. This perspective emphasises that effective DRR must initiate transformative processes to build resilience against increasing global challenges while informing the development of post-2030 frameworks and supporting broader Sustainable Development Goals.

BackgroundThe lateral transpsoas lumbar interbody fusion is associated with transient postoperative anterior thigh and inguinal dysesthesias and hip flexor weakness from manipulation of the psoas and interposed lumbar plexus. However, it remains unclear whether this translates to higher pain scores and opioid requirements.MethodsPatients who had undergone one- or two-level extreme/direct (XLIF/DLIF), anterior (ALIF), or transforaminal lumbar interbody fusion (TLIF) between January 2018 and December 2023 for degenerative spinal pathology were included. All cases were further classified as standalone or pedicle screw-fixated, and pedicle screw-fixated was included as a covariate. Outcomes were assessed using multivariable linear or binary logistic regression and included length of stay (LOS), inpatient daily maximum pain scores, inpatient morphine-equivalent daily dosage, and total inpatient morphine milligram equivalents, 30- and 90-day complications, emergency department visits, return to operating room, and readmission, and 90-day and 1-year Oswestry Disability Index (ODI) and EuroQuol-5 Dimension (EQ5D).ResultsA total of 936 patients were assessed, including 90 (9.6%) XLIF/DLIFs, 587 (62.7%) TLIFs, and 259 (27.6%) ALIFs. Pedicle screw fixation differed significantly between approaches (TLIF: 100%, ALIF: 51.0%, XLIF/DLIF: 51.1%; p<.001). The XLIF/DLIF approach had the shortest operative time compared to ALIF and TLIF (p<.003). Furthermore, XLIF/DLIF approach was associated with lower 90-day ODI than TLIF (β=–21.185; p=.002) and ALIF (β=–9.275; p=.043), higher 90-day EQ5D than TLIF (β=+27.389; p<.001) and ALIF (β=+13.897; p=.001), higher morphine-equivalent daily dosage than TLIF (β=+29.115; p<.001) and ALIF (β=+11.959; p=.006), and shorter LOS than TLIF (β=–45.500 hours; p=.014) and ALIF (β=–24.447 hours; p=.049). No significant differences were observed in maximum pain scores, total inpatient morphine milligram equivalents, complications, readmissions, or return to operating room.ConclusionsDespite a shorter operative time, shorter LOS, and better 90-day ODI and EQ5D, the lateral transpsoas lumbar interbody fusion is associated with higher postoperative inpatient opioid consumption than TLIF and ALIF.Level of EvidenceIII

Aims and Objective:The present study aims to investigate the perioperative outcomes of elderly patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA).Materials and Methods:A retrospective single-center observational study was conducted on elderly patients (>70 years) undergoing SBTKA. Perioperative outcomes were assessed, including the incidence of complications such as cardiac and renal dysfunction, rate of transfusion, and total length of stay (LOS). Descriptive statistical measures were used to summarize study parameters.Results:The average LOS for patients was 4.71 days. A total of 38 incidences of adverse events were recorded. The most common adverse event was acute kidney injury (17.16%). There was a moderate positive correlation between LOS and complications, as well as LOS and blood transfusion requirements. Patients requiring blood transfusions during their hospital stay had a longer LOS of 5.47 days compared to non-transfused patients (4.45 days). Patients with chronic kidney disease had the highest LOS (5.10 days), followed by those with Parkinson’s disease (5.00 days). The LOS was relatively consistent across different age groups.Conclusion:SBTKA is a safe and satisfactory procedure for patients over 70 years old and those with comorbid conditions at a multispecialty hospital with intensive care support. However, delaying surgery when indicated may lead to worse functional outcomes, highlighting the importance of timely intervention.