The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2014
Randomized Controlled Trial Comparative StudyEffect of immobilization without passive exercise after rotator cuff repair: randomized clinical trial comparing four and eight weeks of immobilization.
While animal studies have shown better healing with a longer duration of protection without motion exercise after rotator cuff repair, supporting clinical studies are rare. The purpose of this study was to assess the effect of immobilization following rotator cuff repair and to determine whether there was any difference in clinical outcome related to the duration of immobilization. ⋯ Eight weeks of immobilization did not yield a higher rate of healing of medium-sized rotator cuff tears compared with four weeks of immobilization.
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J Bone Joint Surg Am · Mar 2014
Many diabetic total joint arthroplasty candidates are unable to achieve a preoperative hemoglobin A1c goal of 7% or less.
Patients with poorly controlled diabetes have an elevated risk of complications and death following total joint arthroplasty. Some centers set a threshold hemoglobin A1c (HbA1c) value above which surgery is delayed pending better glycemic control. The purpose of this study was to examine how many diabetic patients scheduled for primary total joint arthroplasty underwent a delay because of an HbA1c value of >7.0%, how many subsequently achieved this goal, and how much time was necessary to achieve this goal. ⋯ When establishing a goal designed to reduce perioperative risks, there should be an expectation that the goal is achievable. Overall, an HbA1c of ≤7.0% was achieved by 380 of the 404 diabetic patients (94%; 95% confidence interval [CI], 91% to 96%), but it was achieved by only thirty-five (59%; 95% CI, 46% to 72%) of the fifty-nine patients presenting with an HbA1c of >7.0%. An HbA1c of 8.0% was achieved by 395 (98%; 95% CI, 96% to 99%) of the diabetic patients and by twenty-one (70%; 95% CI, 50% to 85%) of the thirty patients presenting with an HbA1c of >8.0%. Achieving an HbA1c value of ≤7.0% may not be possible for certain diabetic patients, and such a requirement may risk access to total joint arthroplasty treatment.
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J Bone Joint Surg Am · Mar 2014
Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma.
The aim of this study was to determine factors associated with self-reported ongoing use of opioid medication one to two months after operative treatment of musculoskeletal trauma. ⋯ Patients who continue to use opioid pain medication one to two months after surgery for musculoskeletal trauma have more psychological distress, less effective coping strategies, and greater symptoms and disability than patients who do not take opioids, irrespective of injury, surgical procedure, or surgeon.
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J Bone Joint Surg Am · Mar 2014
Early corrosion-related failure of the rejuvenate modular total hip replacement.
The Rejuvenate modular-neck stem implant (Stryker Orthopaedics, Mahwah, New Jersey) was recently recalled due to corrosion at the femoral neck-stem junction. The purpose of this study was to investigate the rate of corrosion-related failure and survivorship of this implant and analyze the correlation of implant and patient factors with serum metal ion levels and revisions. ⋯ The short-term high rate of corrosion-related revision with Rejuvenate modular-neck stems is striking.
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J Bone Joint Surg Am · Mar 2014
Randomized Controlled TrialMetal ion levels after metal-on-metal total hip arthroplasty: a five-year, prospective randomized trial.
The U.S. Food and Drug Administration has requested post-market surveillance data, including data on metal ion levels, regarding metal-on-metal total hip arthroplasty. We performed a prospective, randomized study of metal ion levels in erythrocytes, serum, and whole blood at five years after 28 and 36-mm metal-on-metal and 28-mm metal-on-polyethylene total hip arthroplasty. ⋯ The 36-mm metal-on-metal bearing underperformed the 28-mm metal-on-metal bearing with respect to metal ion levels. The authors are closely following all patients treated with metal-on-metal total hip arthroplasty.