California Northstate University

BACKGROUND:Kinematic alignment (KA) total knee arthroplasty (TKA) seeks to restore native limb and knee alignments regardless of the degree of preoperative deformity and/or flexion contracture. Hence, the thickness of each femoral resection should match the femoral component after adjusting for cartilage wear and sawblade kerf. Previously, the thickness of worn articular cartilage has been set at 2 mm. If the proportion of patients with thickness ≥3 mm is relatively large however, then adjusting resection thickness to reflect cartilage thickness is a refinement of interest. The objectives were to determine the proportion of patients undergoing KA TKA with cartilage thickness ≥3 mm in each resection. METHOD:Using calibrated photographs, articular cartilage thickness was measured on 456 unworn resections (i.e. distal medial and lateral, posterior medial and lateral) from 201 patients undergoing KA TKA. The proportion of patients with cartilage thickness ≥3 mm was determined for each resection. RESULTS:The proportions of patients with cartilage thickness ≥3 mm were 29% and 34% for the distal medial and lateral resections, respectively, and 36% and 23% for the posterior medial and lateral resections, respectively. CONCLUSION:The relatively large proportion of patients with cartilage thickness ≥3 mm motivates taking next steps to assess the clinical practicality of adjusting resection thickness to reflect cartilage thickness. One next step is to determine how accurately cartilage thicknesses of worn distal and posterior surfaces can be predicted by measuring thickness of the contralateral unworn distal surface.

Microneedle technology represents a promising advancement in transdermal drug delivery, offering painless administration, enhanced patient compliance, elimination of cold chain requirements, and self-administration capabilities. Despite extensive development with over 4,000 patents, commercial translation remains limited to 13 products, predominantly cosmetic applications. Economic evaluations demonstrate microneedle patches achieve cost-effectiveness at price points below 30 per dose. Operational savings range from0.24-0.61 per dose across vaccination scenarios (≥ 87

PURPOSE:A goal of kinematic alignment (KA) total knee arthroplasty (TKA) is to align the femoral component to restore the distal and posterior femoral joint lines to prearthritic. To restore the joint line on the worn distal condyle, the resection thickness is adjusted by 2 mm for cartilage loss based on the reported average cartilage thickness on magnetic resonance imaging. It remains unclear whether a 2 mm fixed adjustment is ideal for all patients, especially those with thicker cartilage. This study examined whether a 2 mm fixed adjustment in patients with cartilage thickness ≥3.0 mm negatively affects the Forgotten Joint Score (FJS), Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) compared to those with cartilage thickness <3.0 mm. METHODS:In 96 KA TKAs with preoperative varus (85%) and valgus (15%) deformities, cartilage thickness was measured using a calibrated photographic method on a medial-lateral bisection of the unworn distal femoral condyle. At 1 year after surgery, equivalence was assessed in FJS, OKS and KOOS JR between patients with cartilage thickness ≥3.0 mm and those with <3.0 mm. RESULTS:The overall average cartilage thickness was 2.8 ± 0.6 mm (range, 1.6-5.0 mm), with 41% having a cartilage thickness ≥3.0 mm. The mean FJS was 78 versus 74 points for those with <3.0 and ≥3.0 mm cartilage, and these results were statistically equivalent (p = 0.0150). Similarly, mean OKS scores of 42 versus 41 points (p = 0.0071), and KOOS JR scores of 80 versus 81 points, were statistically equivalent (p < 0.0001). CONCLUSION:Although a large percentage of patients had unworn cartilage thickness ≥3 mm, outcome scores were comparble to patients with thickness <3 mm. Hence, surgeons can use a 2 mm fixed adjustment for cartilage loss, even when the cartilage thickness exceeds 3 mm, with a range up to 5.0 mm, without negatively affecting the FJS, OKS or KOOS JR. LEVEL OF EVIDENCE:Level III.

Active learning and flipped classrooms have gained popularity in higher education due to their ability to improve educational outcomes. This study evaluated whether combining voiceover lectures and review games could improve learner engagement and satisfaction while achieving learning outcomes comparable to those of traditional immunology didactic lectures. A total of 123 first- and second-year medical students were randomly assigned to groups that took formative quizzes on immunology material after exposure to either: (i) a traditional didactic lecture, (ii) a voiceover lecture followed by an in-class discussion of the voiceover and subsequent review game, or (iii) a blind control group that had no exposure to the material. Furthermore, students provided feedback on the pedagogy and their learning preferences. Students were very enthusiastic about the review games and preferred shorter voiceovers containing formative questions embedded within the voiceover. Importantly, there was no significant difference in quiz performance between the 2 pedagogies, and both groups performed significantly better than the blind control group. A slight but significant decrease in student preference for voiceovers was noted throughout the duration of this multiyear study, which occurred during and shortly after the COVID-19 pandemic. Faculty who observed this pedagogy expressed an increased willingness to use voiceovers and review games if they received training and information technology support. Collectively, this longitudinal study demonstrated support from both faculty and students for the combined use of voiceovers plus review games and captured a potential shift in medical student preferences for learning in recent years during the COVID-19 pandemic.