The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jul 2009
The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty.
As the prevalence of diabetes mellitus in people over the age of sixty years is expected to increase, the number of diabetic patients who undergo total hip and knee arthroplasty should be expected to increase accordingly. In general, patients with diabetes are at increased risk for adverse events following arthroplasty. The goal of the present study was to determine whether the quality of preoperative glycemic control affected the prevalence of in-hospital peri-operative complications following lower extremity total joint arthroplasty. ⋯ Regardless of diabetes type, patients with uncontrolled diabetes mellitus exhibited significantly increased odds of surgical and systemic complications, higher mortality, and increased length of stay during the index hospitalization following lower extremity total joint arthroplasty.
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J Bone Joint Surg Am · Jul 2009
Allograft-prosthetic composite reconstruction of the proximal part of the tibia. An analysis of the early results.
Allograft-prosthetic composite reconstruction of the proximal part of the tibia is one option following resection of a skeletal tumor. Previous studies with use of this technique have found a high prevalence of complications, including fracture, infection, extensor mechanism insufficiency, and loosening. To address some of these problems, we adopted certain measures, including muscle flap coverage, meticulous tendon reconstruction, rigid implant fixation, and careful rehabilitation. The goal of the present study was to evaluate the functional outcome and complications in patients undergoing allograft-prosthetic composite reconstruction of the proximal part of the tibia. ⋯ After osteoarticular resection of destructive tumors of the proximal part of the tibia, an allograft-prosthetic composite reconstruction can provide consistently good functional results with an acceptably low complication rate. Technical aspects of the procedure that may favorably affect outcome include soft-tissue coverage with muscle flaps and rigid fixation with a long-stemmed implant.
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J Bone Joint Surg Am · Jun 2009
Randomized Controlled Trial Multicenter Study Comparative StudyClinical and radiographic analysis of an optimized rhBMP-2 formulation as an autograft replacement in posterolateral lumbar spine arthrodesis.
Previous studies have demonstrated the ability of recombinant human bone morphogenetic protein to achieve a solid fusion in anterior lumbar interbody arthrodesis. The purpose of this study was to compare iliac crest bone graft and recombinant human bone morphogenetic protein-2, combined with a carrier consisting of bovine collagen and beta-tricalcium phosphate-hydroxyapatite to create a compression-resistant matrix, for instrumented single-level posterolateral arthrodesis. ⋯ The use of recombinant human bone morphogenetic protein-2 in instrumented posterolateral lumbar arthrodesis decreases operative time and blood loss and produces earlier and higher fusion rates than does iliac crest bone graft. Clinical outcomes are similar to those with iliac crest bone graft. Thus, the need for harvesting iliac crest bone is eliminated along with the morbidities associated with the harvest procedure.
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J Bone Joint Surg Am · Jun 2009
Randomized Controlled Trial Multicenter Study Comparative StudySurgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts.
The management of degenerative spondylolisthesis associated with spinal stenosis remains controversial. Surgery is widely used and has recently been shown to be more effective than nonoperative treatment when the results were followed over two years. Questions remain regarding the long-term effects of surgical treatment compared with those of nonoperative treatment. ⋯ Compared with patients who are treated nonoperatively, patients in whom degenerative spondylolisthesis and associated spinal stenosis are treated surgically maintain substantially greater pain relief and improvement in function for four years.
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J Bone Joint Surg Am · Jun 2009
Randomized Controlled TrialRange of motion and quadriceps muscle power after early surgical treatment of acute combined anterior cruciate and grade-III medial collateral ligament injuries. A prospective randomized study.
Early operative treatment of combined anterior cruciate and medial collateral ligament injuries has frequently led to motion complications and slow quadriceps muscle power gains. The purpose of the present study was to evaluate the effect of early repair or nonoperative treatment of a concomitant medial collateral ligament injury on range of motion of the knee and quadriceps muscle strength in patients with combined injuries. ⋯ Early operative treatment of combined anterior cruciate and medial collateral ligament injuries is possible without increased long-term mobilization complications. The rehabilitation period is long, and aggressive physiotherapy is recommended. However, nonoperative treatment of the torn medial collateral ligament allows faster restoration of flexion and quadriceps muscle power. Our results favor nonoperative treatment of the torn medial collateral ligament in patients with combined injuries.