The Journal of bone and joint surgery. American volume
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Reherniation within the first year following subtotal lumbar discectomy is a rare but noteworthy event. We performed a retrospective, case-controlled study to evaluate the clinical outcomes after early recurrent lumbar disc reherniation. ⋯ The rate of early reherniation after subtotal lumbar discectomy is low (1%). It is important to consider the possibility of iatrogenic instability during surgery on the lumbar spine for the treatment of reherniation. Patients who undergo reoperation because of early recurrent lumbar disc herniation can have clinical outcomes comparable with those of patients undergoing an uncomplicated subtotal lumbar discectomy.
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J Bone Joint Surg Am · Jan 2008
Effects of capsular plication and rotator interval closure in simulated multidirectional shoulder instability.
Arthroscopic treatment of multidirectional shoulder instability with use of capsular plication and rotator interval closure has been shown to be effective in several clinical studies; however, the biomechanical effects of these procedures have not been elucidated. The purpose of this study was to assess biomechanically the effect of arthroscopic capsular plication combined with rotator interval closure on rotational range of motion, humeral head position throughout rotation, and glenohumeral translation. ⋯ Capsular plication alone reduces range of motion to the intact state. Reductions in translation, however, may require the addition of rotator interval closure. Changes in translation and rotation after repair are dependent on arm position. In some positions, the addition of rotator interval closure may also result in overtightening.
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J Bone Joint Surg Am · Jan 2008
Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis.
The mobile-bearing feature of the Oxford unicompartmental knee replacement has the potential to optimize polyethylene wear, thereby leading to longer-term function of the implant. The function of the bearing requires intact soft tissues, with the ligaments being balanced throughout the range of motion intraoperatively through bone resection only. Final limb alignment is determined by the restored soft-tissue tension. The purposes of this study were to determine the limb alignment achieved in the absence of ligament release and to investigate the interplay of failure mode, survivorship, and limb alignment. ⋯ With this unicompartmental knee arthroplasty, the mechanical limb alignment resulting from balancing the knee ligaments, accomplished without releasing them, was consistently through the center of the knee. Progression of arthritis in the lateral compartment was the most common reason for late failure in this series and was not related to the initial postoperative alignment.
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J Bone Joint Surg Am · Dec 2007
Revision total hip arthroplasty in octogenarians. A case-control study.
Revision total hip arthroplasty in the very elderly is believed to be associated with a high complication rate. We evaluated the early outcomes and prevalence of complications following revision total hip arthroplasty in patients older than eighty years of age and compared them with those in a younger patient population. ⋯ Revision total hip arthroplasty can provide substantial clinical benefit to patients over eighty years of age. The medical complication rate for octogenarians may not differ significantly from that for patients seventy years of age or younger, and the prevalence of technical complications and dislocations can be expected to be lower than that for younger patients.
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J Bone Joint Surg Am · Dec 2007
Randomized Controlled TrialCorticosteroid injection in diabetic patients with trigger finger. A prospective, randomized, controlled double-blinded study.
It is generally accepted that the initial treatment for trigger finger is injection of corticosteroid into the flexor tendon sheath. In this study, the efficacy of corticosteroid injections for the treatment of trigger finger in patients with diabetes mellitus was evaluated in a prospective, randomized, controlled, double-blinded fashion and the efficacy in nondiabetic patients was evaluated in a prospective, unblinded fashion. ⋯ Corticosteroid injections were significantly more effective in the digits of nondiabetic patients than in those of diabetic patients. In patients with diabetes, corticosteroid injections did not decrease the surgery rate or improve symptom relief compared with the placebo. The use of corticosteroid injections for the treatment of trigger finger may be less effective in patients with systemic manifestations of diabetes mellitus.