The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2013
Fixation, survival, and dislocation of jumbo acetabular components in revision hip arthroplasty.
Acetabular revision of a total hip arthroplasty using jumbo components (Mayo definition, ≥62 mm in women and ≥66 mm in men) offers distinct advantages in patients with notable acetabular bone loss. However, there are little data on the long-term survival and complications associated with use of these components. ⋯ Jumbo acetabular components with screw fixation were associated with low rates of infection and loosening after revision total hip arthroplasty and had high survival at fifteen years. Reoperation for wear and loosening increased in the second decade. Dislocation was the most common complication and was significantly associated with smaller femoral head sizes.
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J Bone Joint Surg Am · Mar 2013
Clinical TrialSix-degrees-of-freedom cervical spine range of motion during dynamic flexion-extension after single-level anterior arthrodesis: comparison with asymptomatic control subjects.
The etiology of adjacent-segment disease following cervical spine arthrodesis remains controversial. The objective of the current study was to evaluate cervical intervertebral range of motion during dynamic flexion-extension in patients who had undergone a single-level arthrodesis and in asymptomatic control subjects. ⋯ C5/C6 arthrodesis does not affect the total range of motion in adjacent vertebral segments, but it does alter the distribution of adjacent-segment motion toward more extension and less flexion superior to the arthrodesis and more posterior translation superior and inferior to the arthrodesis during in vivo functional loading. Range of motion measured from static full-flexion and full-extension images underestimates dynamic range of motion. Clinical evaluation of excessive anterior-posterior translation should take into account the cervical vertebral level.
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J Bone Joint Surg Am · Mar 2013
Repair integrity and functional outcomes for arthroscopic margin convergence of rotator cuff tears.
We evaluated the clinical outcomes of arthroscopic margin convergence for rotator cuff tears. ⋯ Reducing tension by margin convergence followed by a repair of the resulting free edge to bone has reasonable short-term clinical results but a substantial retear rate (47.8%). However, the retears tended to be smaller than the original tear size. No significant difference was observed in the short-term clinical results between the groups with or without a retear.
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J Bone Joint Surg Am · Mar 2013
Meta Analysis Comparative StudyA meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease.
Anterior cervical discectomy and fusion is a standard treatment for symptomatic cervical disc disease, but pseudarthrosis and accelerated adjacent-level disc degeneration may develop. Cervical disc arthroplasty was developed to preserve the kinematics of the functional spinal unit. Trials comparing arthroplasty with anterior cervical discectomy and fusion have shown unclear benefits in terms of clinical results, neck motion at the operated level, adverse events, and the need for secondary surgical procedures. ⋯ The meta-analysis revealed that anterior cervical discectomy and fusion was associated with shorter operative times and less blood loss compared with arthroplasty. Other outcomes after arthroplasty (length of hospital stay, clinical indices, range of motion at the operated level, adverse events, and secondary surgical procedures) were superior or equivalent to the outcomes after anterior cervical discectomy and fusion.
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J Bone Joint Surg Am · Mar 2013
Controlled Clinical TrialTen-year outcome of serum metal ion levels after primary total hip arthroplasty: a concise follow-up of a previous report*.
We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). ⋯ The serum titanium levels were higher in the titanium group at all follow-up time intervals as compared with the levels in all other groups, and the level in the titanium group at 120 months was eighteen times higher than it was at baseline (p < 0.01). Patients with well-functioning primary metal-on-polyethylene total hip replacements had elevated serum metal levels for as many as ten years postoperatively. Furthermore, metal release at the modular femoral head-neck junctions, rather than passive dissolution from porous ingrowth surfaces, was likely the dominant source of serum cobalt and chromium.