The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2013
Common peroneal nerve palsy following total hip arthroplasty: prognostic factors for recovery.
Common peroneal nerve palsy, although rare, is a serious complication of total hip arthroplasty. Although several publications have dealt with the risk factors for peroneal nerve palsy, there is little literature regarding the time it takes for the nerve to recover and the factors that influence its recovery. The purpose of this study was to elucidate the clinical course of this injury and identify prognostic factors for recovery. ⋯ Only one-half of the patients in the study who developed common peroneal nerve palsy following total hip arthroplasty recovered fully. The mean time to recovery was approximately one year for partial peroneal palsy and one and one-half years for complete palsy. Obesity adversely influenced the nerve recovery.
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J Bone Joint Surg Am · May 2013
Elevated postoperative blood glucose and preoperative hemoglobin A1C are associated with increased wound complications following total joint arthroplasty.
Diabetes is an established risk factor for complications following total joint arthroplasty. However, the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following total joint arthroplasty is not well described. ⋯ Patients with a mean postoperative blood glucose of >200 mg/dL or a preoperative hemoglobin A1C level of >6.7% are at increased risk for wound complications following elective primary total joint arthroplasty. These results show that poor preoperative and postoperative glucose control is independently associated with wound complications.
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J Bone Joint Surg Am · May 2013
Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees.
Deep surgical site infection following total knee arthroplasty is a devastating complication. Patient and surgical risk factors for this complication have not been thoroughly examined. The purpose of this study was to evaluate risk factors associated with deep surgical site infection following total knee arthroplasty in a large U.S. integrated health-care system. ⋯ Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · May 2013
Effects of vertebral column distraction on transcranial electrical stimulation-motor evoked potential and histology of the spinal cord in a porcine model.
Spinal cord injury can occur following surgical procedures for correction of scoliosis and kyphosis, as these procedures produce lengthening of the vertebral column. The objective of this study was to cause spinal cord injury by vertebral column distraction and evaluate the histological changes in the spinal cord in relationship to the pattern of recovery from the spinal cord injury. ⋯ Parallel distraction of approximately 3.6% of the thoracolumbar length after global osteotomy resulted in spinal cord injury and histological evidence of spinal cord damage. The pattern of recovery from the spinal cord injury after release of the distraction was consistent with the degree of axonal damage. Axotomy was observed in animals that exhibited no recovery on TES-MEP, and only hemorrhagic changes in the white matter were observed in animals that exhibited incomplete recovery.
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J Bone Joint Surg Am · Apr 2013
Relationship of bicipital groove rotation with humeral head retroversion: a three-dimensional computed tomographic analysis.
Bicipital groove location has been used as a reference for humeral stem orientation in total shoulder arthroplasty to recreate humeral head retroversion. However, anatomic variability has rendered its use for prosthetic orientation problematic in cases of comminuted proximal fractures. We hypothesized that variability in groove rotation is directly related to variability in humeral head retroversion and that by defining the degree of groove rotation, humeral head retroversion can be predicted. ⋯ A previously unknown direct correlation between bicipital groove rotation and humeral head retroversion was found to exist. The ability to predict humeral head retroversion when mapping only the distal third of the groove has potentially important clinical implications because the distal third is often the only portion of the groove remaining in patients with a comminuted proximal humeral fracture. This is particularly relevant with computer-navigated surgery.