The Journal of bone and joint surgery. American volume
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To our knowledge, there has been no prospective study on the results of arthroscopic repair of superior labrum-biceps anchor complex (SLAP) tears with use of modern techniques. The purpose of the present study was to prospectively evaluate the minimum two-year results for patients with type-II SLAP tears that were treated with arthroscopic suture anchor fixation. ⋯ Our findings indicate that favorable outcomes can be anticipated in the majority of patients after arthroscopic SLAP lesion repair. While only three of four patients overall may be capable of returning fully to their previous level of competition, patients with a distinct traumatic etiology have a greater likelihood of a successful return to sports.
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J Bone Joint Surg Am · Jul 2009
Randomized Controlled Trial Multicenter StudyRecombinant human bone morphogenetic protein-2 on an absorbable collagen sponge with an osteoconductive bulking agent in posterolateral arthrodesis with instrumentation. A prospective randomized trial.
Recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge has been shown to be a safe and effective replacement for iliac crest bone graft when used with a threaded fusion device in anterior lumbar interbody arthrodesis. Use of rhBMP-2 on an absorbable collagen sponge in posterolateral lumbar arthrodesis requires the addition of a bulking agent to provide resistance against compression and to serve as an osteoconductive scaffold for new bone formation. ⋯ Compared with an iliac crest bone graft, the combination of an absorbable collagen sponge soaked with rhBMP-2 and ceramic granules resulted in trends toward improvements in clinical outcomes and toward a higher rate of radiographic fusion. This combination of an osteoinductive agent with an osteoconductive matrix may be an effective replacement for autograft in single-level posterolateral lumbar arthrodeses with instrumentation.
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J Bone Joint Surg Am · Jul 2009
The epidemiology of bearing surface usage in total hip arthroplasty in the United States.
Hard-on-hard bearings offer the potential to improve the survivorship of total hip arthroplasty implants. However, the specific indications for the use of these advanced technologies remain controversial. The purpose of this study was to characterize the epidemiology of bearing surface utilization in total hip arthroplasty in the United States with respect to patient, hospital, geographic, and payer characteristics. ⋯ The usage of total hip arthroplasty bearings varies considerably by patient characteristics, hospital type, and geographic location throughout the United States. Despite uncertain advantages in older patients, hard-on-hard bearings are commonly used in patients over the age of sixty-five years. Further study is necessary to define the appropriate indications for these advanced technologies in total hip arthroplasty.
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J Bone Joint Surg Am · Jul 2009
Multicenter StudyEfficacy of intraoperative neurologic monitoring in surgery involving a vertical expandable prosthetic titanium rib for early-onset spinal deformity.
The vertical expandable prosthetic titanium rib (VEPTR) device is used in the treatment of thoracic insufficiency syndrome and certain types of early-onset spinal deformity. The purpose of this study was to evaluate the risk of neurologic injury during surgical procedures involving use of the VEPTR and to determine the efficacy of intraoperative spinal cord neuromonitoring. ⋯ Neurologic injury during VEPTR surgery occurs much more frequently in the upper extremities than in the lower extremities. The rates of potential neurologic injuries (neurologic injuries plus instances of changes detected by monitoring) during primary implantation of the VEPTR (2.8%) and during exchange of the VEPTR (1.3%) justify the use of intraoperative neuromonitoring of the upper and lower extremities during those procedures. As neuromonitoring did not demonstrate any changes in children without a previous VEPTR-related monitoring change and there were no neurologic injuries during more than 1000 VEPTR-lengthening procedures, intraoperative neuromonitoring may not be necessary during those procedures in children without a history of a neurologic deficit during VEPTR surgery.
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J Bone Joint Surg Am · Jul 2009
Surgical treatment of three and four-part proximal humeral fractures.
Optimal surgical management of three and four-part proximal humeral fractures in osteoporotic patients is controversial, with many advocating prosthetic replacement of the humeral head. Fixed-angle locked plates that maintain angular stability under load have been proposed as an alternative to hemiarthroplasty for the treatment of some osteoporotic fracture types. ⋯ In this series, open repair with use of a locked plate resulted in better outcome scores than did hemiarthroplasty in similar patients, especially in those with a three-part fracture, despite a higher overall complication rate. Open reduction and internal fixation of fractures with an initial varus extension pattern should be approached with caution.