The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2007
Comparative StudyNeurophysiological detection of impending spinal cord injury during scoliosis surgery.
Despite the many reports attesting to the efficacy of intraoperative somatosensory evoked potential monitoring in reducing the prevalence of iatrogenic spinal cord injury during corrective scoliosis surgery, these afferent neurophysiological signals can provide only indirect evidence of injury to the motor tracts since they monitor posterior column function. Early reports on the use of transcranial electric motor evoked potentials to monitor the corticospinal motor tracts directly suggested that the method holds great promise for improving detection of emerging spinal cord injury. We sought to compare the efficacy of these two methods of monitoring to detect impending iatrogenic neural injury during scoliosis surgery. ⋯ This study underscores the advantage of monitoring the spinal cord motor tracts directly by recording transcranial electric motor evoked potentials in addition to somatosensory evoked potentials. Transcranial electric motor evoked potentials are exquisitely sensitive to altered spinal cord blood flow due to either hypotension or a vascular insult. Moreover, changes in transcranial electric motor evoked potentials are detected earlier than are changes in somatosensory evoked potentials, thereby facilitating more rapid identification of impending spinal cord injury.
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J Bone Joint Surg Am · Nov 2007
Comparative StudyDisease-specific gender differences among total knee arthroplasty candidates.
Women with knee osteoarthritis are less likely to undergo joint replacement despite greater self-reported disability. The primary aim of the present study was to assess gender differences in the type and magnitude of osteoarthritis-related impairment prior to knee arthroplasty. ⋯ Observed gender differences in strength and function appear to be inherent but are magnified in arthroplasty candidates. Strength and functional decline should be closely monitored in women with knee osteoarthritis to serve as an indicator of worsening condition, and preoperative interventions should reflect these gender-specific impairments.
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J Bone Joint Surg Am · Oct 2007
The effect of stuffing the patellofemoral compartment on the outcome of total knee arthroplasty.
The effect of so-called stuffing of the patellofemoral compartment at the time of total knee arthroplasty (that is, increasing the anterior patellar displacement, the anteroposterior femoral size, or the combined anteroposterior patellofemoral size) has not been well studied. The purpose of the present study was to evaluate the effect of stuffing the patellofemoral compartment on the outcome of primary total knee arthroplasty. ⋯ Our findings do not support the widely held belief that stuffing of the patellofemoral joint results in adverse outcomes after total knee arthroplasty. Furthermore, the need for lateral release appears to be multifactorial and likely involves a more complex set of factors. Thus, without evidence of other identifiable causes of failure, we do not recommend revision for the treatment of pain of an overstuffed knee joint.
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J Bone Joint Surg Am · Oct 2007
Comparative StudyComparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty.
The role of ankle arthroplasty in the treatment of ankle arthritis is controversial. Ankle fusion is commonly performed, but there is ongoing concern about functional limitations and arthritis in the adjacent subtalar joint following ankle arthrodesis. The use of ankle arthroplasty as an alternative to ankle fusion is expanding, but reported results have been limited to those in case series. The purpose of this study was to compare the reoperation rates following ankle arthrodesis and ankle replacement on the basis of observational, population-based data from all inpatient admissions in California over a ten-year period. Our hypothesis was that patients treated with ankle replacement would have a lower risk of undergoing subtalar fusion but a higher overall risk of undergoing major revision surgery. ⋯ This study confirms that, compared with ankle fusion, ankle replacement is associated with a higher risk of complications but also potential advantages in terms of a decreased risk of the patient requiring subtalar joint fusion. Additional controlled trials are needed to clarify the appropriate indications for ankle arthrodesis and ankle replacement.
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J Bone Joint Surg Am · Oct 2007
Lisfranc joint displacement following sequential ligament sectioning.
There are two primary radiographic patterns of Lisfranc instability, transverse and longitudinal. There is no single diagnostic method with which to consistently confirm the diagnosis of an unstable injury. Our purpose was to define which ligament disruptions produce these two injury patterns and to compare the utility of weight-bearing and stress radiographs for detecting each pattern of instability. ⋯ Transverse instability required sectioning of both the interosseous first cuneiform-second metatarsal ligament and the plantar ligament between the first cuneiform and the second and third metatarsals. Longitudinal instability required sectioning of both the interosseous first cuneiform-second metatarsal ligament and the interosseous ligament between the first and second cuneiforms. Compared with weight-bearing radiographs, injury-specific manual stress radiographs showed qualitatively greater displacement when used to evaluate both patterns of instability.