The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Apr 1998
Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long-term results.
Seventy-eight Neer hemiarthroplasties and thirty-six Neer total shoulder arthroplasties were performed at our institution, between January 1, 1976, and December 31, 1985, in ninety-eight patients who were fifty years old or less. Two patients (two shoulders) died, and four patients (four shoulders) were lost to follow-up. The remaining seventy-four hemiarthroplasties (95 per cent) in sixty-four patients and thirty-four total shoulder arthroplasties (94 per cent) in thirty-one patients were included in the clinical analysis as the preoperative and operative records were complete and the patients had been followed for at least five years (mean, 12.3 years) or until revision. ⋯ The risk of revision was higher for the seven shoulders that had had a tear of the rotator cuff at the time of the operation than for the twenty-seven that had not had one (p = 0.029). The data from the present study indicate that a shoulder arthroplasty provides marked long-term relief of pain and improvement in motion; however, nearly half of all young patients who have a shoulder arthroplasty have an unsatisfactory result according to a rating system. Care should be exercised when either a hemiarthroplasty or a total shoulder arthroplasty is offered to patients who are fifty years old or less.
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J Bone Joint Surg Am · Mar 1998
Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture.
Sixty patients who had had operative treatment of a fracture of the femoral neck or an intertrochanteric fracture were allowed to bear weight as tolerated on the injured limb. The average age was seventy-seven years. Computerized gait-testing was performed at one, two, three, six, and twelve weeks postoperatively to quantify weight-bearing. ⋯ During the first three weeks, the patients who had had internal fixation bore substantially less weight than those who had had a hemiarthroplasty. By six weeks, we could detect no significant differences, with the numbers available, among the groups with regard to weight-bearing or other measured gait parameters. We concluded that elderly patients who are allowed to bear weight as tolerated after operative treatment of a fracture of the femoral neck or an intertrochanteric fracture appear to voluntarily limit loading of the injured limb.
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A cross-sectional, community-based survey of a random sample of 1750 of 242,311 Medicare recipients was performed. The patients were at least sixty-five years old and had had a primary or revision knee replacement (either unilaterally or bilaterally) between 1985 and 1989. Three samples were surveyed separately: a national sample (to reflect the United States as a whole) and samples from Indiana and the western part of Pennsylvania (sites chosen for convenience to assess the validity of the findings for the national sample on a regional level). ⋯ In what we believe to be the first community-based study of the outcome of knee replacement, patients reported having significant (p = 0.0001) and persistent relief of pain, improved physical function, and satisfaction with the result two to seven years postoperatively. The findings of the present study suggest that age and obesity do not have a negative impact on patient-relevant outcomes (pain and physical function). Dissemination of these findings has the potential to increase appropriate referrals for knee replacement and thereby reduce the pain and functional disability due to osteoarthrosis of the knee.
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We prospectively gathered data on skiing injuries that had been sustained at the Sugarbush North ski area since 1972 and at the Sugarbush South ski area since 1981. The purpose of the current study was to document the overall rates of injury in children, adolescents, and adults participating in alpine skiing. We also sought to determine the ten most common injuries in each age-group. ⋯ Data on the types of equipment and the binding-release values were collected prospectively from injured skiers and from 2083 non-injured skiers. Of the fifty-nine skiers who sustained a spiral fracture of the tibia, forty-two (71 per cent) had binding-release values that were higher than the average for the uninjured group. We believe that the use of properly functioning modern equipment will decrease the rate of injury, particularly in children.
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J Bone Joint Surg Am · Dec 1997
Fatigue fracture of a forged cobalt-chromium-molybdenum femoral component inserted with cement. A report of ten cases.
Ten patients who had had a total hip replacement with a forged cobalt-chromium-molybdenum femoral prosthesis (Precoat or Precoat Plus) inserted with cement were seen with a fatigue fracture of the stem an average of fifty months (range, nineteen to seventy-four months) postoperatively. The average age of the patients was sixty-one years (range, forty-three to seventy-three years), and the average weight was ninety-six kilograms (range, seventy to 130 kilograms). Eight patients had had a primary total hip replacement, and two had had a revision; all of the acetabular components had been inserted without cement. ⋯ Also, of the seven small stems that were used, six had been implanted in patients who weighed more than eighty kilograms, so there was relative undersizing of the prostheses. Early debonding of the proximal end of a Precoat femoral prosthesis from the cement mantle may occur as a result of a thin cement mantle, leading to loosening and possibly to early fatigue fracture of the stem if the distal portion of the stem remains solidly fixed in the distal portion of the cement column. On the basis of our experience, we recommend that patients who have radiographic evidence of a debonded Precoat femoral component should be informed of the risk of fatigue fracture of the stem and be followed closely even though there may be no symptoms of loosening of the femoral component.