Sydney Hernia Specialists Clinic

This study aimed to evaluate the prevalence of dog erythrocyte antigen 1 (DEA 1) blood type in Sydney and to identify any associations between its prevalence and breed, sex and geographic location of these dogs. This was a retrospective study of 225 dogs that underwent DEA 1 blood typing while donating or receiving blood products at a single institution between 2020 and 2024. Dogs were DEA 1 positive or negative and blood donors or recipients. Logistic regression was used to evaluate differences in the prevalence of DEA 1 positive results between sex, breed and geographic location. Significance was set at P < 0.05. Reasons for blood transfusion, blood product administered and age were documented. Of the dogs that were blood typed (n = 225), 48% (108/225) were DEA 1 positive and 52% (117/225) DEA 1 negative, 105 (46.7%) were donors and 120 (53.3%) recipients. The highest prevalence of DEA 1 type positivity was observed in the Golden Retriever (8/9, 88.9%). Recipients presented primarily for haemorrhage (57/120, 47.5%), most frequently receiving whole blood (89/120, 74.2%) with minimal adverse reactions (3/120, 2.5%). No significant differences were identified in prevalence of DEA 1 positive dogs between breed groups, six most common breeds, sex, geographical location or DEA 1 negative blood types. The prevalence of the DEA 1 blood type in this cohort of dogs in Sydney is comparable to other countries.

Functional alignment (FA) in total knee arthroplasty (TKA) aims to achieve balanced gaps by adjusting implant positioning while minimizing changes to constitutional joint line obliquity (JLO). Although FA uses kinematic alignment (KA) as a starting point, the final implant positions can vary significantly between these two approaches. This study used the Coronal Plane Alignment of the Knee (CPAK) classification to compare differences between KA and final FA positions. A retrospective analysis compared pre-resection and post-implantation alignments in 2,116 robotic-assisted FA TKAs. The lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were measured to determine the arithmetic hip-knee-ankle angle (aHKA = MPTA - LDFA), JLO (JLO = MPTA + LDFA), and CPAK type. The primary outcome was the proportion of knees that varied ≤ 2° for aHKA and ≤ 3° for JLO from their KA to FA positions, and direction and magnitude of those changes per CPAK phenotype. Secondary outcomes included proportion of knees that maintained their CPAK phenotype, and differences between sexes. Overall, 71.6% had an aHKA change ≤ 2°, and 87.0% a JLO change ≤ 3°. Mean aHKA changed from -1.1° (SD 2.8°) in KA to -1.9° (SD 2.3°) in FA (mean difference (MD) -0.83 (SD 2.0); p < 0.001). Mean JLO changed from 173.9° (SD 3.0°) in KA to 174.2° (SD 2.6°) in FA (MD 0.38 (SD 2.3); p < 0.001). CPAK type was maintained in 58.1% of knees, with the proportion highest for Types I (73.9%), II (61.1%), and IV (51.2%). In valgus knees, 67.5% of Type III and 71.7% of Type VI were shifted to neutral phenotypes. There was minimal change to constitutional JLO across all CPAK types (MDs -2.0° to 1.2°). Functional alignment may alter CPAK type, but does not significantly change JLO. A kinematic starting point minimizes changes to native anatomy, while final position with FA provides an optimally balanced TKA.

As advancements in total knee arthroplasty progress at an exciting pace, two areas are of special interest, as they directly impact implant design and surgical decision making. Knee morphometry considers the three-dimensional shape of the articulating surfaces within the knee joint, and knee phenotyping provides the ability to categorize alignment into practical groupings that can be used in both clinical and research settings. This annotation discusses the details of these concepts, and the ways in which they are helping us better understand the individual subtleties of each patient's knee.

While mechanical alignment (MA) is the traditional technique in total knee arthroplasty (TKA), its potential for altering constitutional alignment remains poorly understood. This study aimed to quantify unintentional changes to constitutional coronal alignment and joint line obliquity (JLO) resulting from MA. A retrospective cohort study was undertaken of 700 primary MA TKAs (643 patients) performed between 2014 and 2017. Lateral distal femoral and medial proximal tibial angles were measured pre- and postoperatively to calculate the arithmetic hip-knee-ankle angle (aHKA), JLO, and Coronal Plane Alignment of the Knee (CPAK) phenotypes. The primary outcome was the magnitude and direction of aHKA, JLO, and CPAK alterations. The mean aHKA and JLO increased by 0.1° (SD 3.4°) and 5.8° (SD 3.5°), respectively, from pre- to postoperatively. The most common phenotypes shifted from 76.3% CPAK Types I, II, or III (apex distal JLO) preoperatively to 85.0% IV, V, or VI (apex horizontal JLO) postoperatively. The proportion of knees with apex proximal JLO increased from 0.7% preoperatively to 11.1% postoperatively. Among all MA TKAs, 60.0% (420 knees) were changed from their constitutional alignments into CPAK Type V, while 40.0% (280 knees) either remained in constitutional Type V (5.0%, 35 knees) or were unintentionally aligned into other CPAK types (35.0%; 245 knees). Fixed MA targets in TKA lead to substantial changes from constitutional alignment, primarily a significant increase in JLO. These findings enhance our understanding of alignment alterations resulting from both unintended changes to knee phenotypes and surgical resection imprecision.

Orthopaedic surgeons are currently faced with an overwhelming number of choices surrounding total knee arthroplasty (TKA), not only with the latest technologies and prostheses, but also fundamental decisions on alignment philosophies. From 'mechanical' to 'adjusted mechanical' to 'restricted kinematic' to 'unrestricted kinematic' - and how constitutional alignment relates to these - there is potential for ambiguity when thinking about and discussing such concepts. This annotation summarizes the various alignment strategies currently employed in TKA. It provides a clear framework and consistent language that will assist surgeons to compare confidently and contrast the concepts, while also discussing the latest opinions about alignment in TKA. Finally, it provides suggestions for applying consistent nomenclature to future research, especially as we explore the implications of 3D alignment patterns on patient outcomes.Cite this article: Bone Joint J2023;105-B(2):102-108.

Median canaliform nail dystrophy (MCD) is a rare nail abnormality with an unknown etiology. We report the case of MCD of both great toenails in a 2-year-old boy presenting with a fir tree nail pattern and longitudinal splits. MCD was treated with topical marigold therapy (Tagetes sp.). By 15 weeks, the proximal 50% of the MCD had normalized. The report highlights a potential new treatment of marigold therapy for MCD.

Portable accelerometer-based navigation devices (PAD) in total knee arthroplasty (TKA) have been proposed to combine the alignment precision of computer navigation with the efficiency of conventional instrumentation (CON). The aim of this study was to determine if PAD was more effective than CON in TKA in improving clinical outcomes at medium term follow-up. Participants undergoing primary TKA were randomly assigned to either PAD or CON. The primary outcome was the mean between-group difference in the four subscales of the Knee injury and Osteoarthritis Outcome Score (∆KOOS4 ) between preoperative status and latest follow-up. Secondary outcomes included analysis of between-group differences in all KOOS subscales, Western Ontario and McMaster Universities Osteoarthritis Index (∆WOMAC) scores, complications and reoperation rates. Of the 178 participants allocated to a treatment arm, 159 (89.3%) completed follow-up at a mean of 4.3 years (range 3.2-5.8 years). There was no statistically significant or clinically meaningful difference in ∆KOOS4 between preoperative status and latest follow-up (PAD=41, CON=43; p=0.5). There was no difference in mean ∆WOMAC scores (PAD=39, CON=41; p=0.9) or ∆KOOS subscales between groups. In addition, there were no differences in complications or reoperations between groups. PAD was not superior to CON in improving patient-reported outcomes or reducing complications and reoperation rates at medium term follow-up. The use of PAD in TKA to improve clinical outcomes alone cannot be justified based on the results of this study.