Acta orthopaedica
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Implantation of antibiotic-loaded beads is used for orthopedic infections. However, recent in vitro reports have emphasized that bacteria can persist on-or even colonize-antibiotic-impregnated bone cement. We therefore assessed whether bacterial adherence and growth could be determined on gentami-cin- and gentamicin-vancomycin-loaded beads that had been removed after eradication of infection. ⋯ Persistence of bacterial growth on bone cement remains a hazardous problem in orthopedic surgery. Adherence of bacteria to cement can lead to emergence of bacterial resistance to antibiotics and might result in clinical recurrence of infection.
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Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction after total hip and knee replacement surgery. ⋯ We identified several patient characteristics that influence postoperative outcome, LOS, and patient satisfaction in our series of consecutive fast-track joint replacement patients, enabling further attention to be paid to certain aspects of surgery and rehabilitation.
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Giant cell tumors of bone rarely metastasize but often recur locally after surgery. There is limited knowledge about the risk of recurrence related to different types of treatment. ⋯ Intralesional surgery should be the first choice in most giant cell tumors, even in the presence of a pathological fracture. After thorough evacuation, the cavity should be filled with cement.
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Comparative Study
Additive effects of PTH and bisphosphonates on the bone healing response to metaphyseal implants in rats.
When PTH is used to increase the amount of bone in osteoporotic patients, combination with bisphosphonates is known to attenuate the response. This might be explained by the reduced number of remodeling sites after bisphosphonate treatment, which reduces the number of cells able to respond to PTH. However, in a repair situation after trauma, a large number of osteoblasts reside in the wound site. If their activity is no longer coupled to osteoclasts, decreased resorption by bisphosphonates and stimulation of osteoblastic activity by PTH should both (independently) increase bone formation. Thus, we hypothesized that in contrast to the case in osteoporosis treatment, PTH and bisphosphonates have an additive effect in situations involving bone regeneration. ⋯ Because bisphosphonates mainly influence osteoclasts, and intermittent administration of PTH mainly influences osteoblasts, our findings indicate that to a large extent these cells work without coupling in this model. It appears that bisphosphonates are unlikely to attenuate the response to PTH during the formation of new bone.
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Increased intradiscal pressure and relative segmental hypermobility are in vitro observations supporting the idea of increased postoperative load being a reason for progressive degeneration of the free mobile segment adjacent to a lumbar fusion. These mechanisms have been difficult to confirm in clinical studies, and an alternative theory claims instead that the adjacent segment degeneration follows a natural degenerative course in patients who are predisposed. We examined 9 patients 5 years after lumbar fusion, to assess whether relative hypermobility of the segment adjacent to fusion could be correlated to progressive degeneration of the same segment. ⋯ Hypermobility of the segment adjacent to fusion is not a general finding. Increased mobility that can be seen in certain individuals does not impair the 5-year result. The significance of mechanical alterations in adjacent segment degeneration is uncertain, and it is possibly overestimated.