Data on manual or primary THAs were extracted from studies including robotic or revision THAs. Thirty-five articles reporting on 630,675 hips that underwent THA between 1996 and 2016 met our criteria. Results The overall weighted average operative time was 93.20 minutes (range, 55.65 to 149.00 minutes). When the study cohorts were stratified according to average operative time, the highest number fell into the 90 to 99-minute range. Operative time was stable throughout the years reported. Factors that led to increased operative times included increased body mass index (BMI), less surgical experience, and the presence of a trainee. Conclusions The average operative time across the included articles was approximately 95 minutes and has been relatively stable over the past 2 decades. On the basis of our findings, we cannot support CMS lowering the procedural valuation of THA given the stability of its operative times and the relationship between operative time and cost. In 2014, Maryland received a waiver for the Global Budget Revenue (GBR) program.  https://www.selleckchem.com/products/ki16198.html  We evaluated GBR's impact on patient and hospital trends for total knee arthroplasty (TKA) in Maryland compared with the U.S. Specifically, we examined (1) patient characteristics, (2) inpatient course, and (3) costs and charges associated with TKAs from 2014 through 2016. Methods A comparative analysis of TKA-treated patients in the Maryland State Inpatient Database (n = 36,985) versus those in the National Inpatient Sample (n = 2,117,191) was performed. Patient characteristics included race, Charlson Comorbidity Index (CCI), morbid obesity, patient income status, and primary payer. Inpatient course included length of hospital stay (LOS), discharge disposition, and complications. Results In the Maryland TKA cohort, the proportion of minorities increased from 2014 to 2016 while the proportion of whites decreased (p = 0.001). The proportion of patients with a CCI of ≥3 decreased (p = 0.014), that of low-income patients increased (Level IV. See Instructions for Authors for a complete description of levels of evidence. The identification of surgical risk factors for early anterior cruciate ligament (ACL) revision is important when appropriate treatment for patients undergoing primary ACL reconstruction is selected. The purposes of this study were to determine the short-term ACL revision rate of patients undergoing primary ACL reconstruction and to identify surgical risk factors for ACL revision within 2 years of primary ACL reconstruction. Methods This study was based on data collected prospectively from the Norwegian and Swedish National Knee Ligament Registries. Patients who underwent primary ACL reconstruction from 2004 through 2014 were included. We examined revisions through 2016. The relative risks (RRs) of revision ACL reconstruction dependent on graft fixation, the time interval between injury and surgical procedure, and meniscal and cartilage injury were estimated by using generalized linear models with a binomial distribution and log-link function. The outcome was set as revision ACL reconstruction during the firsntly lower risk of ACL revision. Level of Evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Recent studies have suggested that the epiphyseal tubercle serves as a fulcrum for rotation in slipped capital femoral epiphysis (SCFE). However, radiographic evidence of the rotational mechanism is limited. In this study, we describe a novel radiographic staging system for SCFE based on the anatomic relationship between the epiphyseal tubercle and the metaphyseal socket. Methods We reviewed the cases of 469 patients with SCFE who were treated at our institution between 2000 and 2017. SCFE was classified according to our proposed staging system using the preoperative lateral radiograph. Normal hips were considered to be Stage 0. In Stage 1, the tubercle is concentric within its metaphyseal socket, which is enlarged and may present peritubercle radiolucency. In Stage 2, there is evidence of eccentricity of the tubercle, which remains in contact with the posterior wall of the socket. In Stage 3, the tubercle and metaphyseal lucency reach the posterior cortex of the femoral neck. A complete dislodgment of the tuoposed staging system for SCFE is highly reliable and correlates well with the severity of SCFE based on the degree of displacement, with moderate correlation shown for stability. This new staging system helps in understanding the rotational mechanism of SCFE, warranting further investigation to determine its clinical application. Clinical Relevance The novel classification has the potential for the identification of hips that demonstrate subtle SCFE or are at pre-slip stage, or those at risk for osteonecrosis of the femoral head, failure of fixation, or slip progression. Acute flaccid myelitis (AFM) is a debilitating illness that is defined by the sudden onset of flaccid paralysis in the extremities with spinal magnetic resonance imaging (MRI) demonstrating a longitudinal lesion confined to the gray matter. The purpose of this study was to report the types of upper-extremity palsy and outcomes of surgical reconstruction in patients with AFM. Methods Eight patients with a median age at onset of 3.8 years (range, 2.3 to 9.9 years) were identified. There was loss of shoulder abduction and external rotation in all patients, loss of elbow flexion in 5 patients, complete or partial loss of hand function in 3 patients, and spinal accessory nerve palsy in 2 patients. All patients underwent surgical reconstruction, which was categorized into 3 main groups nerve transfer, secondary muscle transfer, and free muscle transfer. Results The median follow-up period was 39 months (range, 30 to 94 months). Four patients obtained ≥90° of shoulder abduction whereas the other 4 patients had shoulder abduction of ≤70°. The 5 patients who received free muscle transfer or nerve transfer to restore elbow function obtained ≥140° of elbow flexion. Two patients treated with free muscle transfer to restore finger function obtained satisfactory total active motion of the fingers (180°). Conclusions The patterns of paralysis and the strategy and outcomes of surgical reconstruction for patients with AFM differed from those for traumatic and obstetric brachial plexus palsy. All patients had loss of shoulder abduction, and 2 had spinal accessory nerve palsy. Restoration of shoulder function was unpredictable and depended on the quality of the donor nerves and recovery of synergistic muscles. Restoration of elbow and hand function was more consistent and satisfactory. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete list of levels of evidence.