The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · May 2015
Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery.
The present study was designed to clarify which underlying indications can be currently considered the main reasons for failure after total knee arthroplasty as a function of time. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
-
J Bone Joint Surg Am · May 2015
Randomized Controlled Trial Multicenter StudyClinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study.
The effectiveness of extracorporeal shock wave therapy in the treatment of plantar fasciitis is controversial. The objective of the present study was to test whether focused extracorporeal shock wave therapy is effective in relieving chronic heel pain diagnosed as plantar fasciitis. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
-
J Bone Joint Surg Am · May 2015
Comparative StudyFluoroscopic radiation exposure: are we protecting ourselves adequately?
While traditional intraoperative fluoroscopy protection relies on thyroid shields and aprons, recent data suggest that the surgeon's eyes and hands receive more exposure than previously appreciated. Using a distal radial fracture surgery model, we examined (1) radiation exposure to the eyes, thyroid, chest, groin, and hands of a surgeon mannequin; (2) the degree to which shielding equipment can decrease exposure; and (3) how exposure varies with fluoroscopy unit size. ⋯ Surgeons' hands receive the most radiation exposure during distal radial plate fixation under fluoroscopy. There was a small but insignificant difference in mean exposure between standard fluoroscopy and mini-fluoroscopy, but some standard units resulted in lower exposure than some mini-units. On the basis of these findings, we recommend routine protective equipment to mitigate exposure to surgeons' hands and eyes, in addition to the thyroid, chest, and groin, during fluoroscopy procedures.
-
J Bone Joint Surg Am · May 2015
ReviewAcetabular fractures in the elderly: evaluation and management.
Acetabular fracture patterns in the elderly, with increased involvement of the anterior column, quadrilateral plate comminution, medialization of the femoral head, and marginal impaction, differ from those noted among a younger cohort. Poor prognostic factors for open reduction and internal fixation (ORIF) are posterior wall comminution, marginal impaction of the acetabulum, a femoral head impaction fracture, a so-called gull sign, and hip dislocation. The rate of conversion to total hip arthroplasty following formal ORIF has been reported to be 22% at a mean of twenty-nine months. Total hip replacement after an acetabular fracture generally yields good clinical results; however, in the acute setting, it must be combined with proper stable fracture fixation.
-
J Bone Joint Surg Am · May 2015
Comparative StudyReliability, validity, and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for elderly patients with a femoral neck fracture.
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture. ⋯ The results are based on two clinical trials. The questionnaires used concern pure, clinically relevant issues (ability to walk, climb stairs, etc.). Moreover, the results can be used for future research comparing clinical outcomes (or treatments) for populations with a femoral neck fracture.