The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2003
Comparative StudySurgeon experience and clinical and economic outcomes for shoulder arthroplasty.
Previous studies have demonstrated that a high surgical volume for certain surgical procedures reduces morbidity and improves economic outcome; however, to our knowledge, no study has demonstrated a similar relationship between volume and outcome for total shoulder arthroplasty and hemiarthroplasty. The objective of this study was to determine whether increased surgeon experience was associated with improved clinical and economic outcomes for patients undergoing total shoulder arthroplasty or hemiarthroplasty. ⋯ This study indicates that the patients of surgeons with higher average annual caseloads of total shoulder arthroplasties and hemiarthroplasties have decreased complication rates and hospital lengths of stay compared with the patients of surgeons who perform fewer of these procedures. These analyses of hospital discharge data are limited because of a lack of prospective data, operative details, and patient outcomes data. However, this study emphasizes the importance of continued education for orthopaedic surgeons who perform shoulder arthroplasty.
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J Bone Joint Surg Am · Dec 2003
Magnetic resonance imaging of patellofemoral kinematics with weight-bearing.
Previous studies of the patellofemoral joint have been limited by the use of invasive techniques, measurements under non-weight-bearing conditions, cadaveric specimens, or computerized models. It has been shown that soft tissue and bone can be accurately quantified with magnetic resonance imaging. The present study was designed to define the relationship between the patellofemoral contact area and patellofemoral kinematics in vivo. ⋯ We found that lateral patellar subluxation and tilt occurred in these normal knees at full extension and the patella was reduced into the trochlear groove at 30 degrees of flexion. Therefore, we believe that lateral patellar tilt and subluxation observed during arthroscopy of the extended knee may not represent a pathological condition.
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J Bone Joint Surg Am · Nov 2003
Intramedullary nailing of humeral shaft fractures with a locking flexible nail.
Studies on intramedullary nailing of humeral shaft fractures in the orthopaedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of a new flexible, locking intramedullary nail that can be implanted in the humerus in either a retrograde or an antegrade manner without violating the rotator cuff mechanism or damaging the articular surface of the humeral head. ⋯ The flexible humeral nail allows both retrograde and antegrade implantation and static locking. Nail insertion can be accomplished without violating the rotator cuff or damaging the articular surface of the humeral head. Although the nail functioned well in most of our patients, the use of a small-diameter (7.5-mm) nail was associated with a higher complication rate. This implant should be used with caution in any patient with a medullary canal diameter of
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J Bone Joint Surg Am · Nov 2003
Comparative StudyEndogenous cortisol production in response to knee arthroscopy and total knee arthroplasty.
There is controversy about whether patients who take exogenous glucocorticoids, such as prednisone, require supplemental (exogenous) glucocorticoids in order to meet the physiological demands of surgery. In this study, we sought to define the magnitude of the surgical stress response in normal patients undergoing major and minor elective orthopaedic surgery. ⋯ Patients undergoing total knee arthroplasty had a significant surgical stress response (a seventeenfold increase in the cortisol-to-creatinine clearance ratio); patients treated with arthroscopy did not. Additional studies, including a prospective trial of patients taking exogenous glucocorticoids, are warranted. Until they are performed, the significantly increased cortisol production observed in non-steroid-dependent patients following total knee arthroplasty leaves open the possibility that steroid-dependent patients undergoing this procedure could benefit from perioperative glucocorticoid supplementation. Since the non-steroid-dependent patients in the present series did not mount a substantial stress response to knee arthroscopy, our results do not support the use of supplemental steroids for that less-invasive procedure.