The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2014
One-stage exchange arthroplasty for chronic periprosthetic hip infection: results of a large prospective cohort study.
Exchange arthroplasty of one or two stages is required for the treatment of chronic periprosthetic joint infections. Two-stage exchange is costly and has high morbidity with limited patient mobility between procedures. One-stage exchange has been promoted by several European teams as the preferred alternative. The aim of this study was to prospectively analyze the outcome of patients with a periprosthetic hip infection treated with one-stage exchange arthroplasty. ⋯ One-stage exchange arthroplasty is an effective surgical procedure in patients with periprosthetic hip infection who have good bone quality. Precise identification of the microorganism(s) and prolonged administration of appropriate intravenous antibiotic therapy are key factors for successful treatment.
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J Bone Joint Surg Am · Jan 2014
Intrawound vancomycin powder eradicates surgical wound contamination: an in vivo rabbit study.
Surgical site infection remains a complication of spine surgery despite routine use of prophylactic antibiotics. Retrospective clinical studies of intrawound vancomycin use have documented a decreased prevalence of surgical site infection after spine surgery. The purpose of the present study was to assess the efficacy of intrawound vancomycin powder in terms of eradicating a known bacterial surgical site contamination in a rabbit spine surgery model. ⋯ This animal study supports the findings in prior clinical reports that intrawound vancomycin powder helps reduce the risk of surgical site infections.
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J Bone Joint Surg Am · Dec 2013
Effect and possible mechanism of muscle-splitting approach on multifidus muscle injury and atrophy after posterior lumbar spine surgery.
Multifidus muscle injury and atrophy are common after posterior lumbar spine surgery and are associated with low back pain and functional disability. In theory, muscle-splitting and retraction with a self-retaining retractor are considered to be the major surgical factors. The effects and mechanisms of retraction have been well studied, but the exact effect and possible mechanism of injury and atrophy after muscle-splitting still lack experimental evidence. ⋯ This study provides a basis for the prevention of multifidus muscle injury and atrophy after posterior lumbar surgery.
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J Bone Joint Surg Am · Dec 2013
ReviewUpper-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.
Over the past twenty-five years, peripheral nerve blocks have become increasingly common for the management of perioperative pain of the upper extremity. Several factors have led to increasing acceptance and use of these peripheral nerve blocks, including a greater awareness and measurement of patient pain and a greater emphasis on decreasing the duration of hospital stays and associated costs. ⋯ The use of peripheral nerve blocks in upper-extremity surgery is common. To actively participate with the patient and anesthesiologist to ensure the best possible outcomes, the orthopaedic surgeon must be well informed regarding the benefits and limitations of this modality.
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J Bone Joint Surg Am · Dec 2013
Surgeon, implant, and patient variables may explain variability in early revision rates reported for unicompartmental arthroplasty.
The reported revision rates for cemented unicompartmental knee arthroplasties have varied widely. The effect of implant selection, patient characteristics, and surgeon characteristics on revision risk has not been evaluated fully. The purpose of the present study was to determine the impact of these variables on the risk for aseptic revision arthroplasty. ⋯ Implant selection can have a considerable effect on the risk for aseptic revision following a cemented unicompartmental knee arthroplasty, as can patient and surgeon factors. Therefore, the variation among risk estimates reported in the literature for unicompartmental knee arthroplasty revision may be explained by differences in patient characteristics and implant selection as well as the surgeons' yearly volume of unicompartmental knee arthroplasties.