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Introduction Reports from the current literature show a lack of detail with depictions of the genicular arteries (GA). The intricate anatomy and infrequency of operating in the posterior knee may lead to surgeons being unfamiliar with the anatomy. The goal of this cadaveric study was to quantitatively map the arteries and create a caution zone that can be utilized when preparing and performing surgical procedures involving the knee. Materials and methods The left knees of 46 cadavers were used. The distance of the GAs were from the joint line (JL) (+, superior to JL; −, inferior to JL) was measured in two locations: popliteal artery (PA) branch point and medial/lateral knee. The angle the artery traveled between these two points in the posterior knee was measured. A caution map was created. Results The superolateral GA branched from PA at +47.3 mm and traveled superiorly at 57.7° to +52.2 mm at the lateral knee. The superomedial GA branched from PA at +55.2 mm and traveled superiorly at 66.8° to +57.3 mm at the medial knee. The inferolateral GA branched from PA at −0.6 mm. It traveled superiorly at 74.1° or inferiorly at 62.1° to −1.0 mm at the lateral knee. The inferomedial GA branched from the PA at +9.9 mm. It traveled inferiorly at 21.2° to −33 mm at the medial knee. Conclusion The GAs have a predictable pattern of location in the knee. There is a mismatch between medical textbooks and reality regarding arterial depictions. Knowledge regarding where the arteries are located may help reduce vascular complications in patients in the future.

Introduction Total hip arthroplasty (THA) is a frequently performed surgery. Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the United States and has been associated with higher complications in many orthopedic surgeries. The purpose of this study was to examine the clinical and economic impacts of COPD on the mortality, cost, and length of stay of those undergoing THA and the effect of hospital teaching status on these outcomes. Methods This retrospective cohort study identified adult patients (≥18 years) utilizing information from the Healthcare Cost and Utilization Program Nationwide Inpatient Sample (NIS) from 2012 to 2014 undergoing elective THA using ICD-9 codes. Patients missing key clinical identifiers or those who did not undergo THA were excluded. Mortality, cost, and length of stay were assessed. The COPD cohort was further analyzed by hospital teaching status, including urban teaching, urban non-teaching, and rural. Results An adjusted total of 7,652 patients with COPD and 768,000 patients without COPD undergoing THA were identified. COPD was associated with higher mortality rates, longer lengths of stay, and total charges. In the COPD cohort, teaching status did affect outcomes. Between urban teaching hospitals and urban non-teaching, chronic conditions were significantly higher in urban teaching hospitals, yet total charges were lower. LOS was longer in rural hospitals, however, all other variables, including costs, were not significantly different as compared to urban teaching hospitals. Between urban non-teaching hospitals and rural hospitals, the number of chronic conditions and LOS were higher in rural hospitals, yet costs were significantly less. Age and mortality rates were not significantly different between different teaching statuses. Conclusion COPD has a significant effect on mortality, length of stay, and cost in patients undergoing THA. Additionally, teaching status seems to play an interesting role in these variables. Preoperative planning may help surgeons mitigate some of these risks associated with COPD. Further work on how LOS and costs are optimized with regards to teaching status should be done.

Spinal epidural abscesses are insidious infections spread via hematologic, contiguous, or iatrogenic routes. On average, spinal epidural abscesses span two to four vertebral segments and are most commonly localized to the thoracic region. Fever, back pain, and neurological deficits are the most common clinical manifestations. However, the triad of these findings are not always detected. Patients may present with subtle symptoms leading to misdiagnosis and poor prognosis. We present a case of a large, anteriorly located, spinal epidural abscess in a patient originally admitted for dyspnea and confusion.