The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 2009
Randomized Controlled Trial Multicenter Study Comparative StudyClinical and radiographic analysis of an optimized rhBMP-2 formulation as an autograft replacement in posterolateral lumbar spine arthrodesis.
Previous studies have demonstrated the ability of recombinant human bone morphogenetic protein to achieve a solid fusion in anterior lumbar interbody arthrodesis. The purpose of this study was to compare iliac crest bone graft and recombinant human bone morphogenetic protein-2, combined with a carrier consisting of bovine collagen and beta-tricalcium phosphate-hydroxyapatite to create a compression-resistant matrix, for instrumented single-level posterolateral arthrodesis. ⋯ The use of recombinant human bone morphogenetic protein-2 in instrumented posterolateral lumbar arthrodesis decreases operative time and blood loss and produces earlier and higher fusion rates than does iliac crest bone graft. Clinical outcomes are similar to those with iliac crest bone graft. Thus, the need for harvesting iliac crest bone is eliminated along with the morbidities associated with the harvest procedure.
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J Bone Joint Surg Am · Jun 2009
Randomized Controlled Trial Multicenter Study Comparative StudySurgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts.
The management of degenerative spondylolisthesis associated with spinal stenosis remains controversial. Surgery is widely used and has recently been shown to be more effective than nonoperative treatment when the results were followed over two years. Questions remain regarding the long-term effects of surgical treatment compared with those of nonoperative treatment. ⋯ Compared with patients who are treated nonoperatively, patients in whom degenerative spondylolisthesis and associated spinal stenosis are treated surgically maintain substantially greater pain relief and improvement in function for four years.
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J Bone Joint Surg Am · Jun 2009
Randomized Controlled TrialRange of motion and quadriceps muscle power after early surgical treatment of acute combined anterior cruciate and grade-III medial collateral ligament injuries. A prospective randomized study.
Early operative treatment of combined anterior cruciate and medial collateral ligament injuries has frequently led to motion complications and slow quadriceps muscle power gains. The purpose of the present study was to evaluate the effect of early repair or nonoperative treatment of a concomitant medial collateral ligament injury on range of motion of the knee and quadriceps muscle strength in patients with combined injuries. ⋯ Early operative treatment of combined anterior cruciate and medial collateral ligament injuries is possible without increased long-term mobilization complications. The rehabilitation period is long, and aggressive physiotherapy is recommended. However, nonoperative treatment of the torn medial collateral ligament allows faster restoration of flexion and quadriceps muscle power. Our results favor nonoperative treatment of the torn medial collateral ligament in patients with combined injuries.
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J Bone Joint Surg Am · Jun 2009
Randomized Controlled Trial Comparative StudyEarly recovery after total knee arthroplasty performed with and without patellar eversion and tibial translation. A prospective randomized study.
Proponents of minimally invasive total knee arthroplasty claim that patellar eversion and anterior tibial translation during total knee arthroplasty have a deleterious effect on early patient rehabilitation and the early clinical outcome. Our purpose was to identify differences in knee preference and clinical outcome measures in a series of patients who had undergone bilateral total knee arthroplasty with each knee randomized to one of two different surgical approaches: patellar eversion and anterior tibial translation, or patellar subluxation and no tibial translation. ⋯ We found no significant differences between the two treatment groups (patellar eversion and anterior tibial translation compared with patellar subluxation and no tibial translation) at six weeks, twelve weeks, or six months after the surgery. We concluded that patellar eversion and anterior tibial translation appear to have no adverse effects on the range of motion, quadriceps strength, or patient's knee preference during the early postoperative recovery period after total knee arthroplasty.
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J Bone Joint Surg Am · Jun 2009
Comparative StudyDistal radial fracture treatment: what you get may depend on your age and address.
Distal radial fractures are common and confer a considerable financial burden on the health-care system; however, controversy surrounds the optimal treatment of these injuries. This study was performed to determine (1) the rate of distal radial fractures in the U.S. Medicare population stratified by hospital referral region and (2) whether the type of fracture treatment is affected by patient age, race, sex, comorbidity, or hospital referral region. ⋯ There is wide variation in the rate of distal radial fractures across sex, age, race, and geographic region in the United States. There is also significant variation in the treatment of these fractures, driven mainly by age and region. Between 1998 and 2004, a strong trend toward more frequent operative fixation was apparent. While white individuals had more than twice as many fractures as did non-white individuals, there did not appear to be significant racial variation in the treatment of this injury.