The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2013
Management of failures of total ankle replacement with the agility total ankle arthroplasty.
Few studies have focused on treatment following failed total ankle replacement. The purpose of this study was to report the outcomes of patients undergoing revision total ankle replacement and to propose a talar component subsidence grading system that may be helpful in making decisions regarding how to revise failed total ankle replacements in the future. ⋯ Revision arthroplasty may be considered as an alternative to arthrodesis when treating patients with a failed Agility total ankle implant.
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When possible, direct repair remains the current standard of care for the repair of peripheral nerve lacerations. In large nerve gaps, in which direct repair is not possible, grafting remains the most viable option. Nerve scaffolds include autologous conduits, artificial nonbioabsorbable conduits, and bioabsorbable conduits and are options for repair of digital nerve gaps that are <3 cm in length. Experimental studies suggest that the use of allografts may be an option for repairing larger sensory nerve gaps without associated donor-site morbidity.
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J Bone Joint Surg Am · Dec 2013
Randomized Controlled TrialAssessment of femoral head and head-neck junction perfusion following surgical hip dislocation using gadolinium-enhanced magnetic resonance imaging: a cadaveric study.
The purpose of the present study was to quantify perfusion to the femoral head and head-neck junction using gadolinium-enhanced magnetic resonance imaging following three surgical dislocations of the hip (trochanteric flip osteotomy, standard posterior approach, and modified posterior approach). ⋯ Our study provides previously unreported quantitative magnetic resonance imaging data on the perfusion to the femoral head and head-neck junction during common surgical approaches to the hip.
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J Bone Joint Surg Am · Dec 2013
Assessment of three-dimensional lumbar spine vertebral motion during gait with use of indwelling bone pins.
This study quantifies the three-dimensional motion of lumbar vertebrae during gait via direct in vivo measurement with the use of indwelling bone pins with retroreflective markers and motion capture. Two previous studies in which bone pins were used were limited to instrumentation of two vertebrae, and neither evaluated motions during gait. While several imaging-based studies of spinal motion have been reported, the restrictions in measurement volume that are inherent to imaging modalities are not conducive to gait applications. ⋯ This is a valid model for measuring the three-dimensional motion of the spine. Normative data were obtained to better understand the effects of spine disorders on vertebral motion over the gait cycle.
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J Bone Joint Surg Am · Dec 2013
Multicenter StudyThe natural progression of synovial fluid white blood-cell counts and the percentage of polymorphonuclear cells after primary total knee arthroplasty: a multicenter study.
Assessments of the synovial fluid white blood-cell (WBC) count and percentage of polymorphonuclear cells (PMNs) have been reported to be useful in the diagnosis of periprosthetic joint infection. The purpose of this multicenter retrospective study was to evaluate the natural progression of the synovial fluid WBC count, PMN percentage, and total neutrophil count in patients who underwent knee aspiration during the first two years after primary total knee arthroplasty and had no evidence of periprosthetic joint infection. ⋯ The synovial fluid WBC count and PMN percentage changed at different rates over the first two years after total knee arthroplasty, with the WBC count exhibiting an initially more rapid decrease and the PMN percentage demonstrating a more linear decrease. Hence, the total neutrophil count, which combines these two parameters, may provide a better method to identify patients with a periprosthetic joint infection. Values for the synovial fluid WBC count, PMN percentage, and total neutrophil count were all significantly elevated in the early postoperative period, and the use of standard cutoff values for the diagnosis of periprosthetic joint infection can lead to false-positive results.