Acta orthopaedica
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The pathophysiology behind bisphosphonate-associated atypical femoral fractures remains unclear. Histological findings at the fracture site itself may provide clues. ⋯ Atypical femoral fractures show signs of attempted healing at the fracture site. The narrow width of the fracture gap and its necrotic contents are compatible with the idea that micromotion prevents healing because it leads to strains within the fracture gap that preclude cell survival.
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Editorial Comment
Arthroscopy for degenerative knee--a difficult habit to break?
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Randomized Controlled Trial
Local anesthetic wound infiltration for pain management after periacetabular osteotomy. A randomized, placebo-controlled, double-blind clinical trial with 53 patients.
To our knowledge, there is no evidence to support the use of local infiltration analgesia (LIA) for postoperative pain relief after periacetabular osteotomy (PAO). We investigated the effect of wound infiltration with a long-acting local anesthetic (ropivacaine) for postoperative analgesia after PAO. ⋯ The clinical importance of ropivacaine as single component in postoperative treatment of pain is questionable, and we are planning further studies to explore the potential of LIA in larger volume-and also a multimodal regimen-to treat pain in this category of patients.
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There are very few data concerning the outcome after short-segment posterior stabilization and anterior spondylodesis with rib grafts in patients suffering from unstable thoracolumbar burst fractures. We have therefore investigated the clinical and radiographic outcome after posterior bisegmental instrumentation and monosegmental anterior spondylodesis using an autologous rib graft for unstable thoracolumbar burst fractures. ⋯ Short-segment posterior instrumentation and anterior spondylodesis using an autologous rib graft resulted in sufficient correction of posttraumatic segmental kyphosis. There was no clinically relevant correction loss, and the majority of patients had no back complaints at the 2-year follow-up.
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Multicenter Study
Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively.
The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO change score and the acceptable postoperative PRO score, by estimating MCII and PASS 1 year after total hip arthroplasty (THA) for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D. ⋯ This study improves the interpretability of PRO scores. The different estimation approaches presented may serve as a guide for future MCII and PASS estimations in other contexts. The cutoff points may serve as reference values in registry settings.