Peroneal neuropathy is the most common compressive neuropathy of the lower extremity. It should be included in the differential diagnosis for patients presenting with foot drop, the pain of the lower extremity, or numbness of the lower extremity. Symptoms of peroneal neuropathy may occur due to compression of the common peroneal nerve (CPN), superficial peroneal nerve (SPN), or deep peroneal nerve (DPN), each with different clinical presentations. The CPN is most commonly compressed by the bony prominence of the fibula, the SPN most commonly entrapped as it exits the lateral compartment of the leg, and the DPN as it crosses underneath the extensor retinaculum. Accurate and timely diagnosis of any peroneal neuropathy is important to avoid progression of nerve injury and permanent nerve damage. The diagnosis is often made with physical exam findings of decreased strength, altered sensation, and gait abnormalities. Motor nerve conduction studies, electromyography studies, and diagnostic nerve blocks can also assist in diagnosis and prognosis. First-line treatments include removing anything that may be causing external compression, providing stability to unstable joints, and reducing inflammation. Although many peroneal nerve entrapments will resolve with observation and activity modification, surgical treatment is often required when entrapment is refractory to these conservative management strategies. Recently, additional options including microsurgical decompression and percutaneous peripheral nerve stimulation have been reported; however, large studies reporting outcomes are lacking.

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Background:Robotic-assisted (RA) technology is becoming increasingly popular in total knee arthroplasty (TKA) due to its improved alignment, accuracy, and precision compared with the conventional TKA. Despite reported benefits, disagreements exist regarding patientreported outcomes and complication rates comparing RA TKA and conventional TKA. Thus, the purpose of the study is to report differences in patient outcomes and complication rates between patients who underwent RA versus conventional TKA. Methods:The authors retrospectively reviewed 239 primary knee arthroplasty cases (n = 137 robot-assisted and n = 102 conventional TKA) performed by a single fellowship-trained orthopaedic surgeon from January 1, 2016 to February 26, 2019. The electronic medical record and patient outcomes database were reviewed for demographic characteristics (age, sex, body mass index, and comorbidities), patient-reported outcomes (Short Form Health Survey and Oxford Knee Score), 90-day complications, and revision rates. Results:There was no statistically significant difference in patient-reported outcomes between conventional versus RA groups at two time points: preoperative and 2-year. Differences remained insignificant after controlling for age, sex, body mass index, and comorbidities. There was no statistically significant difference between the conventional and RA groups in revision rates (0.7% and 1%, respectively; P = 1.00) or complication rates (1.5% and 3.9%, respectively; P = 0.406). Conclusions:There were no differences in 90-day complications, revisions, and patient-reported outcome scores between RA TKA and conventional TKA groups at short-term follow-up. Surgeons can expect similar clinical outcomes without an increase in complications while taking advantage of increased accuracy in alignment and component placement. Further long-term study of RA TKA outcomes is warranted.

Introduction and ObjectivesIn patients with localized prostate cancer, 5-fraction, stereotactic body radiation therapy (SBRT) has been found to offer comparable oncologic outcomes and potential for improved treatment compliance compared to conventional, 40-plus fraction radiation therapy (RT). Recent studies of oncologic patient experiences have highlighted both the impact of therapy-associated financial toxicity (FT) on treatment adherence and health-related quality of life (HRQOL).MethodsA cross-sectional assessment of FT after SBRT was performed using the 12-item COST questionnaire. The total questionnaire score (range 0–44) was used to evaluate the FT grade (0–3), with a higher COST value representing lower grade. The patient zip code was used to approximate the distance from the index hospital. Univariate and multivariate analyses of the average COST score (0–4) are performed.ResultsThe response rate was 57.5% (332 of 575 consented patients) with 90.7%, 8.2%, and 1.1% experiencing grade 0, 1, and 2 FT, respectively, with no grade 3. Unemployment or disability, non-white race, low income, and concurrent hormonal therapy were associated with a statistically significant worse FT (lower COST value) on univariate and multivariate analyses (p < 0.05). Education level and insurance status significant were evaluated on univariate analysis only. There was a non-statistically significant difference in age, marital status, time since treatment, and distance from the index hospital.ConclusionsSBRT was associated with low FT. However, statistically significant socioeconomic disparities in FT remain despite ultra-hypofractionated treatment.

Background Ejaculatory dysfunction is an important male quality of life issue which has not yet been studied in the setting of prostate stereotactic body radiation therapy (SBRT). Aim The purpose of this study is to evaluate ejaculatory function following SBRT for prostate cancer. Methods Two hundred and thirty-one patients on a prospective quality of life study with baseline ejaculatory capacity treated with prostate SBRT from 2013 to 2019 were included in this analysis. Ejaculation was assessed via the Ejaculation Scale (ES-8) from the Male Sexual Health Questionnaire. Patients completed the questionnaire at 1, 3, 6, 9, 12, 18, and 24 months post-SBRT. Elderly patients (Age > 70) and those who received hormonal therapy were excluded from analysis. Patients were treated to 35–36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Outcomes Ejaculatory function was assessed by ES-8 scores (range 4–40) with lower values representing increased interference or annoyance. Results Median age at the time of treatment was 65 years. Median follow up was 24 months (IQR 19–24.5 months). 64.5% of patients had ED at baseline (SHIM < 22). The 2-year anejaculation rate was 15%. Mean composite ES-8 scores showed a decline in the first month following treatment then stabilized: 30.4 (start of treatment); 26.5 (1 month); 27.6 (3 month); 27.0 (6 month); 26.2 (9 month); 25.4 (12 month); 25.0 (18 month) and 25.4 (24 month). White race, higher pre-treatment SHIM (≥22), and higher ES-8 (≥31) at treatment start were significantly associated with a decreased probability of a clinically significant decline. Patient-reported ejaculate volume was significantly reduced at all time points post-SBRT. Ejaculatory discomfort peaked at 1 month and 9 months post-SBRT. Prior to treatment, 8.0% of men reported that they were very to extremely bothered by their ejaculatory dysfunction. The number of patients reporting this concern increased to 14.4% at one year and dropped to 11% at 24-months post-SBRT. Clinical Translation Patients undergoing prostate SBRT may experience meaningful changes in ejaculatory function and should be counseled on the trajectory of these side effects. Strengths & Limitations This was a retrospective analysis of a prospectively maintained database. Subjective questionnaire responses captured limited aspects of ejaculatory function in this cohort. Conclusion The high incidence of moderate to extreme bother in ejaculatory function before and after SBRT suggests a need for novel approaches to improving ejaculation.