The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2011
Comparative StudyChronic opioid use prior to total knee arthroplasty.
Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after total knee arthroplasty. The purpose of this study was to evaluate patients who underwent total knee arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively. ⋯ Patients who chronically use opioid medications prior to total knee arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the knee.
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J Bone Joint Surg Am · Nov 2011
Randomized Controlled Trial Comparative StudyTemperature-sensitive release of prostaglandin E₂ and diminished energy requirements in synovial tissue with postoperative cryotherapy: a prospective randomized study after knee arthroscopy.
Local external cooling of the surgical field after joint surgery is intended to enhance recovery and to facilitate the use of outpatient surgery by reducing pain and improving mobility. We hypothesized that the effects of postoperative cooling and compression after knee arthroscopy would be reflected in changes in the concentrations of metabolic and inflammatory markers in the synovial membrane. ⋯ Local cryotherapy and compression after knee arthroscopy significantly lowered the temperature in the knee postoperatively, and the synovial PGE₂ concentration was correlated with the temperature. Since PGE₂ is a marker of pain and inflammation, the postoperative local cooling and compression appeared to have a positive anti-inflammatory effect.
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J Bone Joint Surg Am · Nov 2011
Randomized Controlled Trial Multicenter Study Comparative StudyInterobserver reliability of radial head fracture classification: two-dimensional compared with three-dimensional CT.
The Broberg and Morrey modification of the Mason classification of radial head fractures has substantial interobserver variation. This study used a large web-based collaborative of experienced orthopaedic surgeons to test the hypothesis that three-dimensional reconstructions of computed tomography (CT) scans improve the interobserver reliability of the classification of radial head fractures according to the Broberg and Morrey modification of the Mason classification. ⋯ Although three-dimensional CT led to some small but significant decreases in interobserver variation, there is still considerable disagreement regarding classification and characterization of radial head fractures. Three-dimensional CT may be insufficient to optimize interobserver agreement.
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J Bone Joint Surg Am · Nov 2011
Comparative StudyRevision surgery following operations for lumbar stenosis.
For carefully selected patients with lumbar stenosis, decompression surgery is more efficacious than nonoperative treatment. However, some patients undergo repeat surgery, often because of complications, the failure to achieve solid fusion following arthrodesis procedures, or persistent symptoms. We assessed the probability of repeat surgery following operations for the treatment of lumbar stenosis and examined its association with patient age, comorbidity, previous surgery, and the type of surgical procedure. ⋯ The likelihood of repeat surgery for spinal stenosis declined with increasing age and comorbidity, perhaps because of concern for greater risks. The strongest clinical predictor of repeat surgery was a lumbar spine operation prior to the index operation. Arthrodeses were not significantly associated with lower rates of repeat surgery after the first postoperative year, and patients who had had complex arthrodeses had the highest rate of reoperations.
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J Bone Joint Surg Am · Nov 2011
The stabilizing effect of the distal interosseous membrane on the distal radioulnar joint in an ulnar shortening procedure: a biomechanical study.
The importance of the stabilizing effect of the distal interosseous membrane on the distal radioulnar joint, especially in patients with a distal oblique bundle, has been described. The purpose of this study was to evaluate the stability of the distal radioulnar joint after an ulnar shortening osteotomy and to quantify longitudinal resistance to ulnar shortening when the osteotomy was proximal or distal to the ulnar attachment of the distal interosseous membrane. These relationships were characterized for forearms with or without a distal oblique bundle. ⋯ Ulnar shortening with the osteotomy carried out proximal to the attachment of the distal interosseous membrane had a more favorable effect on stability of the distal radioulnar joint compared with distal osteotomy, especially in the presence of a distal oblique bundle.