Like other tumors, chondrosarcoma must induce neovascularity as they grow. Recent studies have demonstrated that chondrosarcoma are vascular. Since normal cartilage is a hypoxic, yet avascular tissue and since chondrosarcoma bears some phenotypic relation to cartilage, it is not clear if hypoxic pathways remain intact in these tissues. Hypoxia-inducible factor l a (HIF-la) is the inducible subunit of the HIF-1 transcription factor that regulates genes involved in the response to hypoxia, some of which promote neovascularity. Vascular endothelial growth factor (VEGF) is one of the genes upregulated by HIF-1 and is the primary cytokine related to angiogenesis. In this study we examined the response of chondrocytes and chondrosarcoma cell lines to hypoxia. We found that both normal and malignant chondrocytes increased HIF-1 a protein expression in an oxygen concentration dependent manner and also increased VEGF mRNA expression in response to hypoxia. HIF-la protein and VEGF mRNA decreased when chondrosarcoma cells were transfected with siRNA targeting HIF-la prior to hypoxia exposure, suggesting that HIF-la expression resulted in increased VEGF expression. The role of the HIF-1cLNEGF pathway in angiogenesis in chondrosarcoma in vivo and its usefulness as a target for antiangiogenic treatment strategies for this tumor requires further investigation.

Staphylococcus aureus (S. aureus) is an independent risk factor for orthopaedic surgical site infection (SSI). To determine whether a preoperative decolonization protocol reduces S. aureus SSIs, we conducted a prospective observational study of patients undergoing elective total joint arthroplasty (TJA) at our institution, with two control groups. The concurrent control group comprised patients of surgeons who did not participate in the intervention study. The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study. Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures. S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery. All 164 of 636 participants (26%) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup. In contrast, 1330 concurrent control patients had 12 S. aureus infections. If these infections had occurred in the 26% of patients expected to be nasal carriers of S. aureus at a given time, the infection rate would have been 3.5% (12 of 345) in the control group. In addition, the overall infection rate of the participating surgeons, including nonstaphylococcal infections, decreased from 2.6% during the preintervention period to 1.5% during the intervention period, translating to an adjusted economic gain of $231,741 for the hospital. The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Background Diffuse-type pigmented villonodular synovitis (PVNS) has a high local recurrence rate and as such can lead to erosive destruction of the involved joint. Multiple surgical modalities exist, but it is unknown which technique best minimizes local recurrence and surgical morbidity. Questions/purposes We compared recurrence rates, arthritis progression, and complications between arthroscopic and open modalities for diffuse PVNS of the knee.