The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2013
Meta Analysis Comparative StudyA meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease.
Anterior cervical discectomy and fusion is a standard treatment for symptomatic cervical disc disease, but pseudarthrosis and accelerated adjacent-level disc degeneration may develop. Cervical disc arthroplasty was developed to preserve the kinematics of the functional spinal unit. Trials comparing arthroplasty with anterior cervical discectomy and fusion have shown unclear benefits in terms of clinical results, neck motion at the operated level, adverse events, and the need for secondary surgical procedures. ⋯ The meta-analysis revealed that anterior cervical discectomy and fusion was associated with shorter operative times and less blood loss compared with arthroplasty. Other outcomes after arthroplasty (length of hospital stay, clinical indices, range of motion at the operated level, adverse events, and secondary surgical procedures) were superior or equivalent to the outcomes after anterior cervical discectomy and fusion.
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J Bone Joint Surg Am · Mar 2013
Controlled Clinical TrialTen-year outcome of serum metal ion levels after primary total hip arthroplasty: a concise follow-up of a previous report*.
We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). ⋯ The serum titanium levels were higher in the titanium group at all follow-up time intervals as compared with the levels in all other groups, and the level in the titanium group at 120 months was eighteen times higher than it was at baseline (p < 0.01). Patients with well-functioning primary metal-on-polyethylene total hip replacements had elevated serum metal levels for as many as ten years postoperatively. Furthermore, metal release at the modular femoral head-neck junctions, rather than passive dissolution from porous ingrowth surfaces, was likely the dominant source of serum cobalt and chromium.
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J Bone Joint Surg Am · Mar 2013
Methods to decrease postoperative infections following posterior cervical spine surgery.
To decrease surgical site infections, we initiated a protocol of preliminary preparation of the skin and surrounding plastic drapes with alcohol foam, and the placement of a suprafascial drain in addition to a subfascial drain in obese patients in 2004. In 2008, we additionally placed 500 mg of vancomycin powder into the wound prior to closure. The purpose of this study was to analyze the infection rates for three groups: Group C (control that received standard perioperative intravenous antibiotics alone), Group AD (alcohol foam and drain), and Group VAD (vancomycin with alcohol foam and drain). ⋯ In this study, preliminary preparation with alcohol foam and the placement of suprafascial drains for deep wounds resulted in one postoperative deep infection in 323 surgical procedures. The addition of intrawound vancomycin powder in 195 consecutive posterior cervical spine surgical procedures resulted in no infections and no adverse effects. To our knowledge, this is the first description of a technique for significantly decreasing postoperative cervical spine infections.
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J Bone Joint Surg Am · Mar 2013
Surgical outcomes of total knee replacement according to diabetes status and glycemic control, 2001 to 2009.
Poor glycemic control in patients with diabetes may be associated with adverse surgical outcomes. We sought to determine the association of diabetes status and preoperative glycemic control with several surgical outcomes, including revision arthroplasty and deep infection. ⋯ No significantly increased risk of revision arthroplasty, deep infection, or deep venous thrombosis was found in patients with diabetes (as defined on the basis of preoperative HbA1c levels and other criteria) compared with patients without diabetes in the study population of patients who underwent elective total knee arthroplasty.
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J Bone Joint Surg Am · Mar 2013
Distal femoral valgus deformity following plate fixation of pediatric femoral shaft fractures.
This study investigated the frequency and potential risk factors associated with the development of distal femoral valgus deformity following plate fixation of diaphyseal femoral fractures in children. ⋯ Distal femoral valgus deformity occurred in 30% of patients with distal diaphyseal fractures and in 12% overall. We advocate long-term monitoring of patients with femoral plate fixation, particularly those in whom the plate is placed ≤20 mm from the distal femoral physis.