The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2013
Relationship of plasma metal ions and clinical and imaging findings in patients with ASR XL metal-on-metal total hip replacements.
Plasma metal ion levels are commonly used in the postoperative follow-up evaluation of patients who have had a metal-on-metal hip arthroplasty. However, the relationship between these levels and clinical and imaging findings is not well known. ⋯ In our sample, with a threshold of 5 ppb, abnormal plasma metal ions were associated with larger sizes of pseudotumors when present, but were not predictive of patient symptoms. Abnormal plasma cobalt levels have a significant association with periprosthetic lucency and presence of pseudotumor. Plasma chromium shows a similar pattern of association with lucency and presence of pseudotumor, although the relationships were not significant. Metal ion analysis should be used in conjunction with clinical and imaging evaluation and not as a sole indirect screening test when evaluating patients following metal-on-metal hip arthroplasty.
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J Bone Joint Surg Am · Nov 2013
Inpatient pulmonary embolism after elective primary total hip and knee arthroplasty in the United States.
The incidence of inpatient pulmonary embolism in patients who have elective primary hip and knee arthroplasty in the United States is unknown. Prior studies have included patients with cancer, trauma, or revisions. The goal of this study was to determine the incidence and risks of inpatient pulmonary embolism after elective arthroplasty by type of procedure. ⋯ Elective total knee arthroplasty is associated with a higher incidence and odds of inpatient pulmonary embolism than is total hip arthroplasty; multiple procedures pose the highest risk for pulmonary embolism and associated mortality.
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J Bone Joint Surg Am · Nov 2013
Comparative StudyComparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients.
Treatment of complex three and four-part proximal humeral fractures with hemiarthroplasty in elderly patients has yielded mixed clinical results. Reverse shoulder arthroplasty has emerged as a treatment option for comminuted proximal humeral fractures for these patients. The purpose of the study was to perform a prospective evaluation of patient outcomes comparing hemiarthroplasty and reverse shoulder arthroplasty for the treatment of comminuted proximal humeral fractures in elderly patients. ⋯ In this series, reverse shoulder arthroplasty resulted in better clinical outcomes and a similar complication rate compared with hemiarthroplasty for the treatment of comminuted proximal humeral fractures in the elderly.
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J Bone Joint Surg Am · Nov 2013
Comparison of native anatomy with recommended safe component orientation in total hip arthroplasty for primary osteoarthritis.
The adverse consequences of impingement, dislocation, and implant wear have stimulated increasing interest in accurate component orientation in total hip arthroplasty and hip resurfacing. The aims of the present study were to define femoral and acetabular orientation in a cohort of patients with primary hip osteoarthritis and to determine whether the orientation of their native hip joints corresponded with established recommendations for implantation of prosthetic components. ⋯ The present findings of native acetabular and femoral orientation in patients with primary hip osteoarthritis support intraoperative component positioning for total hip arthroplasty.