Background Total knee arthroplasty (TKA) serves as a reliable treatment option for patients with end-stage arthritis, but patient dissatisfaction rate remains high. With the projected increase in the volume of arthroplasty operations, surgeons have aimed for methods in which to improve the patient outcomes. Robotic-assisted TKA has become increasingly popular. The learning curve for such technology has been investigated, but these prior studies have only been performed by fellowship-trained arthroplasty surgeons. The goal of this study was to investigate the learning curve for non-fellowship-trained orthopedic surgeons to ameliorate any concerns about increased operative time. Methods Retrospective analysis of robotic-assisted TKAs and manual TKAs, performed by two non-fellowship-trained orthopedic surgeons, was conducted on a total of 160 patients. For each individual surgeon, the robotic-assisted TKAs were divided into 3 cohorts of 20 consecutive patients. Data from 20 consecutive manual TKAs were also gathered for each surgeon. The mean operative times were compared. Cohorts were then grouped together for both surgeons and compared in a similar fashion. Results For surgeon 1, mean operative times were significantly increased for robotic-assisted cohorts compared with those for the manual cohort. For surgeon 2, the first robotic-assisted cohort was significantly longer. However, there were no significant differences for the second and third robotic-assisted cohorts. In the combined surgeon group, there was no significant difference between operative times for the third robotic cohort and the manual cohort. Conclusion This study demonstrates that the general orthopedic surgeon in a community hospital may be able to adequately perform robotic-assisted surgery in a similar timeframe to their manual TKA within their first 40 robotic-arm-assisted TKA.

BackgroundElevated testosterone (T) is routinely reported as a marker of hyperandrogenemia in rodent models for polycystic ovary syndrome (PCOS). In women with PCOS, elevated serum androstenedione (A4) is associated with more severe phenotypes, including a positive correlation with serum T, DHEAS, free androgen index (FAI), LH, and LH/FSH ratio. Furthermore, A4, along with calculated free T and FAI, was identified as one of the best predictors of PCOS in adult women of all ages (18 to > 50 y).ObjectiveThe objective of this study was to investigate serum A4 levels in early adolescent and young adult prenatally androgenized (PNA) female rats, a model for PCOS.MethodsPregnant rats were injected with 5 mg T daily during gestational days 16–19 (PNA rats, experimental group) or an equal volume of vehicle (control group). Female offspring of both groups had tail vein blood drawn for serum analysis at 8 and 16 weeks of age. ELISAs were used to quantify serum A4 and T levels.ResultsSerum A4 and T were elevated in 16-week-old PNA rats compared to controls. There was no significant difference in either hormone at 8 weeks of age.ConclusionsThe PNA rats demonstrated elevated serum A4 and T in young adulthood, as has been observed in women with PCOS, further validating this as a model for PCOS and underscoring the importance of serum A4 elevation as a parameter inherent to PCOS and a rodent model for the disorder. Significant A4 elevation develops between early adolescence and early adulthood in this PNA rat model.

Case: Acrometastasis is extremely rare, accounting for 0.1% of all skeletal metastases. Metastases to the carpus are rarer still. This condition can be the first manifestation of an occult malignancy and generally indicates advanced disease. We present the case of a 53-year-old woman with acrometastasis of squamous cell lung cancer to the trapezium as the initial presentation of her malignancy. Conclusion: The presentation of acrometastasis can mimic infectious or inflammatory processes, leading to an erroneous diagnosis. Although exceptionally uncommon, it is important to consider as a differential diagnosis for a destructive hand lesion.