Evidence-based medicine should be divided into the old (OEBM) and the new (NEBM). The driving forces behind the NEBM, which started in the last decades of the 20th Century, included: 1. larger emphasis on empirical evidence rather than mechanical reasoning; 2. the newly proposed biopsychosocial model to explain especially the chronic diseases other than the older biomedical model, which was more successful in explaining infectious and acute diseases; 3. the unacceptable continuation of the popularity of non-scientific explanations of and remedies for many diseases; and 4. trying to control spiraling medical costs by central guidelines. The current most popular implementation of the NEBM is witnessed in preparing guidelines, which unfortunately became a promotional tool for industry in many instances. The remedy can be in returning to the original purpose of the NEBM, which was a new method of teaching the practice of—rather than practicing—medicine.

Advances in the management of rheumatoid arthritis (RA) have rendered remission an increasingly achievable goal. However, a single, universal definition of remission in RA does not exist. Remission criteria were developed in 1981 by a committee of the American College of Rheumatology (ACR) and have been described according to different com- posite indices. In 2011, a committee of the ACR and the Eu- ropean League against Rheumatism (EULAR) has proposed two remission criteria sets to be applied in clinical trials, a Boolean criteria set and a simplified disease activity index (SDAI), which are more stringent than disease activity score with 28 swollen join count (DAS28) to identify remission. More recently, remission has been described based on rou- tine assessment of patient index data (RAPID3), an index of only patient reported outcomes (PROs). Remission criteria of RAPID3 ≥ 3 and less than one swollen joint (RAPID3 SJ1) is comparable to Boolean criteria and can be implemented in busy clinical settings more easily than indices requiring a laboratory test or formal joint count.

A physician estimate of global status (DOCGL) is among the seven core data set measures to assess patients with rheumatoid arthritis (RA) and included in many rheumatic disease indices. In clinical trials designed to reduce in- flammation, DOCGL is directed to estimate inflammatory activity. However, patients with inflammatory rheumatic diseases also may be affected by organ damage (e.g., to joints in RA, kidneys in SLE, muscles in polymyositis, and so forth.). Furthermore, fibromyalgia has been reported in 20% to 40% of patients with RA and other inflammatory rheumatic diseases, which may complicate their manage- ment. We sought to clarify a global summary of patient status by supplementing DOCGL with three additinal separate (0-10) physician global estimates for inflammation (DOCINF), damage (DOCDAM), and neither inflammation nor damage (DOCNON) (often fibromyalgia, but may be other chronic pain or somatization syndromes). In analyses of new patients with six diagnoses, mean overall DOCGL scores were highest for patients with fibromyalgia, followed by RA, spondyloarthropathy, osteoarthritis, gout, and systemic lupus erythematosus. Among the three subscales, mean DOCINF scores were highest in RA, spondyloar- thropathy, gout, and systemic lupus erythematosus; mean DOCDAM highest in osteoarthritis; and mean DOCNON in fibromyalgia. In patients with RA, mean DOCDAM and DOCNON scores indicated coexistence of clinically impor- tant damage or fibromyalgia in some patients. These data indicate face validity of the three physician global estimates on subscales for inflammation, damage, and symptoms due to neither inflammation nor damage. These estimates reflect the expertise of the rheumatologist and may be helpful to interpret rheumatic disease indices.

Aberrant lymphocytes signaling is one of the numerous mechanisms thought to be responsible for the pathogenesis of autoimmune diseases. One of the most successful ap- proaches to the treatment of autoimmunity is through tar- geting of lymphocytes, whose multiple targetable functions include proliferation, cytokine secretion, and migration. The adhesion process is a critical step, not only for migration but also for their communication with antigen-presenting cells, and is therefore a clear target for therapy. This manuscript will discuss the migration of T cells, which are at the heart of many autoimmune responses. We will review the importance of increasing our comprehension of these events, focusing on migration since they enclose a multitude of potential therapeutic targets for autoimmunity. The interface between lymphocytes and antigen presenting cells and the formation of the immunological synapse will be reported in detail. We will address the following questions: What enables T cells to migrate to sites of injury, and what are the options to intervene? What is the contribution of co-receptors to T cell adhesion? How can we manipulate this knowledge for therapeutic purposes? Finally, we will review the latest data regarding current and future therapeutics that target the adhesion process, describing their strength and weaknesses.

Purpose: The purpose of this study was to determine the incidence of venous thromboembolism (VTE) after hip arthroscopy. Methods: Over the course of 13 months, four surgeons that routinely perform hip arthroscopy participated in a protocol to screen all patients postoperatively for deep venous thrombosis (DVT) using bilateral venous duplex ultrasound at or about the 2 week postoperative time point. All patients were assessed and stratified for VTE risk prior to surgery. Mechanical intraoperative and postoperative chemoprophylaxis were not administered. Perioperative factors, such as weightbearing status after surgery, traction time, and anesthesia type, were recorded. Results: We identified 139 eligible patients (average age 37.7, SD = 12.0) that underwent hip arthroscopy. The incidence of symptomatic VTE was 1.4 percent (2/139). Of the entire patient pool, 81 obtained a follow-up ultrasound. There were no cases of asymptomatic deep vein thrombosis (DVT). There were two symptomatic venous thromboembolic events noted; one DVT and one pulmonary embolus. One patient had no risk factors; the other was overweight and routinely took oral contraceptives. Amongst the patient co- hort, the mean BMI was 25.9 (SD = 4.8). The mean traction time was 58.9 minutes (SD = 23.1). Most patients (71%) were partial weightbearing after the procedure. Conclusion and Clinical Relevance: In patients under- going hip arthroscopy, the rate of postoperative VTE was low, despite the use of prolonged axial traction and surgi- cal proximity to the pelvic veins. Although patients should be counseled preoperatively regarding the risk of VTE, we believe that routine use of pharmacologic prophylaxis is not indicated following hip arthroscopy if patients are properly risk stratified prior to surgery and found to be at low risk for VTE.

Introduction: Subtrochanteric femur fractures remain challenging injuries to treat. Historically, varus malreduc- tion has been linked to the development of nonunion; how- ever, there is a paucity of literature evaluating the impact of sagittal plane malreduction. The purpose of this study was to evaluate the influence of coronal and sagittal plane malreductions on time to union of subtrochanteric femur fractures treated with an intramedullary device. Methods: A retrospective study was performed of all sub- trochanteric fractures (AO/OTA type 32) treated at a single institution. Inclusion criteria consisted of: 1. 18 or more years of age, and 2. fracture stabilization using an intramedullary device. All patients included were followed to union or revi- sion surgery. Radiographic evidence of healing was defined as bridging callus on three of four cortices on AP and lateral views. Delayed union was defined as lack of radiographic healing by 4 months postoperatively and nonunion as lack of healing by 6 months. The definition of malreduction was coronal or sagittal plane deformity greater than 10° at the fracture site. Results: Thirty-five patients met inclusion criteria; 20 men and 15 women with an average age of 55 years (range 19 to 100 years). Mean clinical follow up was 7 months (range 3 to 18 months). Thirty-four of 35 fractures (97%) healed without need for additional surgery. Twenty-one of the 35 fractures (60%) healed within 4 months of surgery. Thirteen fractures (37%) had delayed union, and 1 (2.9%) developed nonunion requiring reoperation. Seven of 35 fractures (20.0%) had a malreduction of greater than 10°, defined as varus (2 fractures), flexion (4 fractures), or both (1 fracture). Of the seven fractures with a malreduction, all (100%) developed a delayed (6) or nonunion (1). Of the 28 fractures without malreduction, 21 (75%) healed within 4 months, 7 (25%) had a delayed union, and none had a nonunion. The presence of a malreduction greater than10° in any plane resulted in a significantly higher rate of delayed or nonunion (p = 0.0005). Conclusion: For patients with subtrochanteric fractures treated with an intramedullary device, malreduction in any plane of greater than 10° resulted in a significantly increased rate of delayed or nonunion or both.

Summary: We reviewed the results of 4,723 day of sur- gery pregnancy tests performed at two of our institution’s locations, our ambulatory surgery center and our acute orthopaedics hospital over a 23 month time period. All pa- tients were scheduled for elective orthopaedic surgery. There were seven positive results (0.15%) and one false negative result (0.02%). The cost per positive result for both hospital locations was $1,005.32. Introduction: Performing elective surgery on pregnant women can harm the mother and fetus. In order to minimize the likelihood of this happening, we administer a urine pregnancy test to each woman of childbearing age on the date of surgery. From November 2009 to September 2011, we performed 4,723 urine human chorionic gonadotropin (hCG) pregnancy tests on the day of surgery. We reviewed the results and cost of each pregnancy test. We then used these results to calculate the percentage of positive tests and the cost of diagnosing each pregnant female on the date of their surgery. Methods: We obtained the records of all urine hCG preg- nancy tests performed from November 2009 to September 2011. Each test was reviewed to determine if the result was positive or negative. Costs were calculated using the charges incurred for a qualitative hCG pregnancy test. We then contacted each patient with a positive result to determine if the urine hCG test results were accurate. Results: 4,723 pregnancy tests were reviewed over a 23 month period with 7 (0.15%) having a positive result. Over the 23 month time period, we were notified of one false nega - tive result (0.02%). The Positive Predictive Value (PPV) was 100% and the Negative Predictive Value (NPV) was 99.9%. The cost of a single urine hCG test was $1.49, the total cost for all 4,723 tests was $7,037.27. The cost of diagnosing 7 positive tests was $1,005.32. Conclusion: Routinely performing urine hCG pregnancy tests on the day of surgery is a cost effective method of pre- venting elective orthopaedic surgery on pregnant women. Of 4,723 women tested 7 had a positive result and 1 had a false negative result. The cost of $1,005.32 for each positive test must be compared with the benefit of not performing elective surgery on a pregnant female.

Purpose: To evaluate the performance of a canal filling hinge device for complex knee arthroplasty. Methods: Thirty-seven (4 primary hinge implantation and 33 revision cases) patients who had undergone arthroplasty with the S-ROM third generation hinge device for a combina- tion of massive bone loss or ligamentous insufficiency were prospectively examined with a minimum of 5-year follow-up. Median age at surgery was 72 years (range: 43 to 87 years). Principal indications included aseptic loosening or massive osteolysis (24 cases), infection (8 cases) and periprosthetic fracture (4 cases). All patients exhibited either grade 2 (N = 12) or grade 3 (N = 25) AORI bone loss or a grade 3 medial ligament deficiency. Results: One patient experienced implant failure (71 months), and one patient suffered late deep infection (36 months). Mean WOMAC score improved from 27 to 62. Four patients required patellar resurfacing for persistent pain. The 5-year survivorship was 86%. Conclusions: While the S-ROM device may offer satis- factory medium term outcome for complex end stage knee disease, we report a high rate of debilitating anterior knee symptoms.

Total knee arthroplasty is a common operation for all types of arthritis, including chronic gouty arthritis. Tophi deposits are a well-known cause of joint destruction, but simultaneous subcutaneous and articular tophaceous gout is exceptional. We report a patient who required bilateral total knee replace- ment for this rare condition.

The technique of compression distraction induced osteogen- esis via the Ilizarov external fixator system has been used for a variety of traumatic limb pathologies that necessitate boney union and limb preservation. In this case report, we describe an uncommon scenario were an Ilizarov external fixator was used to treat an infected nonunion following a below knee amputation.

A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repair of his right hip following failed conservative management of femoroacetabu- lar impingement. His postoperative course was complicated by recurring posterior instability of his right hip initially presenting as a posterior dislocation on postoperative day 19. Iatrogenic disruption of the hip’s static stabilizers in the setting of underlying coxa valga is the likely culprit. Although anterior dislocation following hip arthroscopy has been de- scribed, posterior dislocation has not. Further, we identified a successful and less-invasive approach to the treatment of this complication, in the form of a spica cast. Prior cases pertaining to post-arthroscopy hip instability have only de- scribed operative interventions, such as capsular repair and plication, as effective revision procedures.

We describe a minimally invasive procedure for removal of a distal femur locking plate using arthroscopic as- sistance. Using lateral accessory portals, we performed arthroscopically-assisted removal of distal locking screws. Under fluoroscopic image, proximal screws were removed from the diaphysis. The accessory lateral portal sites used to remove the distal screws were connected. Through this arthrotomy, the plate was elevated from the distal femur and removed without difficulty. With this method we were able to concomitantly visualize the intra-articular regions while accomplishing the hardware removal.

Myeloid sarcoma is a rare neoplasia consisting of immature myeloid cells localized at an extramedullary site. We report a case of a 55-year-old woman with a past medical history of myasthenia gravis (MG) disease treated with thymectomy 17 years earlier who presented with a painful lesion in her right acetabulum. Findings from pathology and imaging are consistent with the diagnosis of a myeloid sarcoma. The patient was treated with chemotherapy with an Acute Myeloid Leukemia protocol. At 1-year following initial presentation, PET scans reveal no further evidence of disease. Further follow up and surveillance is needed to determine if the patient will remain free of disease and recurrence.

Evidence-based medicine should be divided into the old (OEBM) and the new (NEBM). The driving forces behind the NEBM, which started in the last decades of the 20th Century, included: 1. larger emphasis on empirical evidence rather than mechanical reasoning; 2. the newly proposed biopsychosocial model to explain especially the chronic diseases other than the older biomedical model, which was more successful in explaining infectious and acute diseases; 3. the unacceptable continuation of the popularity of non-scientific explanations of and remedies for many diseases; and 4. trying to control spiraling medical costs by central guidelines. The current most popular implementation of the NEBM is witnessed in preparing guidelines, which unfortunately became a promotional tool for industry in many instances. The remedy can be in returning to the original purpose of the NEBM, which was a new method of teaching the practice of—rather than practicing—medicine.

Advances in the management of rheumatoid arthritis (RA) have rendered remission an increasingly achievable goal. However, a single, universal definition of remission in RA does not exist. Remission criteria were developed in 1981 by a committee of the American College of Rheumatology (ACR) and have been described according to different com- posite indices. In 2011, a committee of the ACR and the Eu- ropean League against Rheumatism (EULAR) has proposed two remission criteria sets to be applied in clinical trials, a Boolean criteria set and a simplified disease activity index (SDAI), which are more stringent than disease activity score with 28 swollen join count (DAS28) to identify remission. More recently, remission has been described based on rou- tine assessment of patient index data (RAPID3), an index of only patient reported outcomes (PROs). Remission criteria of RAPID3 ≥ 3 and less than one swollen joint (RAPID3 SJ1) is comparable to Boolean criteria and can be implemented in busy clinical settings more easily than indices requiring a laboratory test or formal joint count.

A physician estimate of global status (DOCGL) is among the seven core data set measures to assess patients with rheumatoid arthritis (RA) and included in many rheumatic disease indices. In clinical trials designed to reduce in- flammation, DOCGL is directed to estimate inflammatory activity. However, patients with inflammatory rheumatic diseases also may be affected by organ damage (e.g., to joints in RA, kidneys in SLE, muscles in polymyositis, and so forth.). Furthermore, fibromyalgia has been reported in 20% to 40% of patients with RA and other inflammatory rheumatic diseases, which may complicate their manage- ment. We sought to clarify a global summary of patient status by supplementing DOCGL with three additinal separate (0-10) physician global estimates for inflammation (DOCINF), damage (DOCDAM), and neither inflammation nor damage (DOCNON) (often fibromyalgia, but may be other chronic pain or somatization syndromes). In analyses of new patients with six diagnoses, mean overall DOCGL scores were highest for patients with fibromyalgia, followed by RA, spondyloarthropathy, osteoarthritis, gout, and systemic lupus erythematosus. Among the three subscales, mean DOCINF scores were highest in RA, spondyloar- thropathy, gout, and systemic lupus erythematosus; mean DOCDAM highest in osteoarthritis; and mean DOCNON in fibromyalgia. In patients with RA, mean DOCDAM and DOCNON scores indicated coexistence of clinically impor- tant damage or fibromyalgia in some patients. These data indicate face validity of the three physician global estimates on subscales for inflammation, damage, and symptoms due to neither inflammation nor damage. These estimates reflect the expertise of the rheumatologist and may be helpful to interpret rheumatic disease indices.

Aberrant lymphocytes signaling is one of the numerous mechanisms thought to be responsible for the pathogenesis of autoimmune diseases. One of the most successful ap- proaches to the treatment of autoimmunity is through tar- geting of lymphocytes, whose multiple targetable functions include proliferation, cytokine secretion, and migration. The adhesion process is a critical step, not only for migration but also for their communication with antigen-presenting cells, and is therefore a clear target for therapy. This manuscript will discuss the migration of T cells, which are at the heart of many autoimmune responses. We will review the importance of increasing our comprehension of these events, focusing on migration since they enclose a multitude of potential therapeutic targets for autoimmunity. The interface between lymphocytes and antigen presenting cells and the formation of the immunological synapse will be reported in detail. We will address the following questions: What enables T cells to migrate to sites of injury, and what are the options to intervene? What is the contribution of co-receptors to T cell adhesion? How can we manipulate this knowledge for therapeutic purposes? Finally, we will review the latest data regarding current and future therapeutics that target the adhesion process, describing their strength and weaknesses.

Purpose: The purpose of this study was to determine the incidence of venous thromboembolism (VTE) after hip arthroscopy. Methods: Over the course of 13 months, four surgeons that routinely perform hip arthroscopy participated in a protocol to screen all patients postoperatively for deep venous thrombosis (DVT) using bilateral venous duplex ultrasound at or about the 2 week postoperative time point. All patients were assessed and stratified for VTE risk prior to surgery. Mechanical intraoperative and postoperative chemoprophylaxis were not administered. Perioperative factors, such as weightbearing status after surgery, traction time, and anesthesia type, were recorded. Results: We identified 139 eligible patients (average age 37.7, SD = 12.0) that underwent hip arthroscopy. The incidence of symptomatic VTE was 1.4 percent (2/139). Of the entire patient pool, 81 obtained a follow-up ultrasound. There were no cases of asymptomatic deep vein thrombosis (DVT). There were two symptomatic venous thromboembolic events noted; one DVT and one pulmonary embolus. One patient had no risk factors; the other was overweight and routinely took oral contraceptives. Amongst the patient co- hort, the mean BMI was 25.9 (SD = 4.8). The mean traction time was 58.9 minutes (SD = 23.1). Most patients (71%) were partial weightbearing after the procedure. Conclusion and Clinical Relevance: In patients under- going hip arthroscopy, the rate of postoperative VTE was low, despite the use of prolonged axial traction and surgi- cal proximity to the pelvic veins. Although patients should be counseled preoperatively regarding the risk of VTE, we believe that routine use of pharmacologic prophylaxis is not indicated following hip arthroscopy if patients are properly risk stratified prior to surgery and found to be at low risk for VTE.

Introduction: Subtrochanteric femur fractures remain challenging injuries to treat. Historically, varus malreduc- tion has been linked to the development of nonunion; how- ever, there is a paucity of literature evaluating the impact of sagittal plane malreduction. The purpose of this study was to evaluate the influence of coronal and sagittal plane malreductions on time to union of subtrochanteric femur fractures treated with an intramedullary device. Methods: A retrospective study was performed of all sub- trochanteric fractures (AO/OTA type 32) treated at a single institution. Inclusion criteria consisted of: 1. 18 or more years of age, and 2. fracture stabilization using an intramedullary device. All patients included were followed to union or revi- sion surgery. Radiographic evidence of healing was defined as bridging callus on three of four cortices on AP and lateral views. Delayed union was defined as lack of radiographic healing by 4 months postoperatively and nonunion as lack of healing by 6 months. The definition of malreduction was coronal or sagittal plane deformity greater than 10° at the fracture site. Results: Thirty-five patients met inclusion criteria; 20 men and 15 women with an average age of 55 years (range 19 to 100 years). Mean clinical follow up was 7 months (range 3 to 18 months). Thirty-four of 35 fractures (97%) healed without need for additional surgery. Twenty-one of the 35 fractures (60%) healed within 4 months of surgery. Thirteen fractures (37%) had delayed union, and 1 (2.9%) developed nonunion requiring reoperation. Seven of 35 fractures (20.0%) had a malreduction of greater than 10°, defined as varus (2 fractures), flexion (4 fractures), or both (1 fracture). Of the seven fractures with a malreduction, all (100%) developed a delayed (6) or nonunion (1). Of the 28 fractures without malreduction, 21 (75%) healed within 4 months, 7 (25%) had a delayed union, and none had a nonunion. The presence of a malreduction greater than10° in any plane resulted in a significantly higher rate of delayed or nonunion (p = 0.0005). Conclusion: For patients with subtrochanteric fractures treated with an intramedullary device, malreduction in any plane of greater than 10° resulted in a significantly increased rate of delayed or nonunion or both.

Summary: We reviewed the results of 4,723 day of sur- gery pregnancy tests performed at two of our institution’s locations, our ambulatory surgery center and our acute orthopaedics hospital over a 23 month time period. All pa- tients were scheduled for elective orthopaedic surgery. There were seven positive results (0.15%) and one false negative result (0.02%). The cost per positive result for both hospital locations was $1,005.32. Introduction: Performing elective surgery on pregnant women can harm the mother and fetus. In order to minimize the likelihood of this happening, we administer a urine pregnancy test to each woman of childbearing age on the date of surgery. From November 2009 to September 2011, we performed 4,723 urine human chorionic gonadotropin (hCG) pregnancy tests on the day of surgery. We reviewed the results and cost of each pregnancy test. We then used these results to calculate the percentage of positive tests and the cost of diagnosing each pregnant female on the date of their surgery. Methods: We obtained the records of all urine hCG preg- nancy tests performed from November 2009 to September 2011. Each test was reviewed to determine if the result was positive or negative. Costs were calculated using the charges incurred for a qualitative hCG pregnancy test. We then contacted each patient with a positive result to determine if the urine hCG test results were accurate. Results: 4,723 pregnancy tests were reviewed over a 23 month period with 7 (0.15%) having a positive result. Over the 23 month time period, we were notified of one false nega - tive result (0.02%). The Positive Predictive Value (PPV) was 100% and the Negative Predictive Value (NPV) was 99.9%. The cost of a single urine hCG test was $1.49, the total cost for all 4,723 tests was $7,037.27. The cost of diagnosing 7 positive tests was $1,005.32. Conclusion: Routinely performing urine hCG pregnancy tests on the day of surgery is a cost effective method of pre- venting elective orthopaedic surgery on pregnant women. Of 4,723 women tested 7 had a positive result and 1 had a false negative result. The cost of $1,005.32 for each positive test must be compared with the benefit of not performing elective surgery on a pregnant female.

Purpose: To evaluate the performance of a canal filling hinge device for complex knee arthroplasty. Methods: Thirty-seven (4 primary hinge implantation and 33 revision cases) patients who had undergone arthroplasty with the S-ROM third generation hinge device for a combina- tion of massive bone loss or ligamentous insufficiency were prospectively examined with a minimum of 5-year follow-up. Median age at surgery was 72 years (range: 43 to 87 years). Principal indications included aseptic loosening or massive osteolysis (24 cases), infection (8 cases) and periprosthetic fracture (4 cases). All patients exhibited either grade 2 (N = 12) or grade 3 (N = 25) AORI bone loss or a grade 3 medial ligament deficiency. Results: One patient experienced implant failure (71 months), and one patient suffered late deep infection (36 months). Mean WOMAC score improved from 27 to 62. Four patients required patellar resurfacing for persistent pain. The 5-year survivorship was 86%. Conclusions: While the S-ROM device may offer satis- factory medium term outcome for complex end stage knee disease, we report a high rate of debilitating anterior knee symptoms.

Total knee arthroplasty is a common operation for all types of arthritis, including chronic gouty arthritis. Tophi deposits are a well-known cause of joint destruction, but simultaneous subcutaneous and articular tophaceous gout is exceptional. We report a patient who required bilateral total knee replace- ment for this rare condition.

The technique of compression distraction induced osteogen- esis via the Ilizarov external fixator system has been used for a variety of traumatic limb pathologies that necessitate boney union and limb preservation. In this case report, we describe an uncommon scenario were an Ilizarov external fixator was used to treat an infected nonunion following a below knee amputation.

A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repair of his right hip following failed conservative management of femoroacetabu- lar impingement. His postoperative course was complicated by recurring posterior instability of his right hip initially presenting as a posterior dislocation on postoperative day 19. Iatrogenic disruption of the hip’s static stabilizers in the setting of underlying coxa valga is the likely culprit. Although anterior dislocation following hip arthroscopy has been de- scribed, posterior dislocation has not. Further, we identified a successful and less-invasive approach to the treatment of this complication, in the form of a spica cast. Prior cases pertaining to post-arthroscopy hip instability have only de- scribed operative interventions, such as capsular repair and plication, as effective revision procedures.

We describe a minimally invasive procedure for removal of a distal femur locking plate using arthroscopic as- sistance. Using lateral accessory portals, we performed arthroscopically-assisted removal of distal locking screws. Under fluoroscopic image, proximal screws were removed from the diaphysis. The accessory lateral portal sites used to remove the distal screws were connected. Through this arthrotomy, the plate was elevated from the distal femur and removed without difficulty. With this method we were able to concomitantly visualize the intra-articular regions while accomplishing the hardware removal.

Myeloid sarcoma is a rare neoplasia consisting of immature myeloid cells localized at an extramedullary site. We report a case of a 55-year-old woman with a past medical history of myasthenia gravis (MG) disease treated with thymectomy 17 years earlier who presented with a painful lesion in her right acetabulum. Findings from pathology and imaging are consistent with the diagnosis of a myeloid sarcoma. The patient was treated with chemotherapy with an Acute Myeloid Leukemia protocol. At 1-year following initial presentation, PET scans reveal no further evidence of disease. Further follow up and surveillance is needed to determine if the patient will remain free of disease and recurrence.