Acta orthopaedica
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The survival of total hip arthroplasties (THAs) has been considered to be poor in young patients. We evaluated the population-based survival of uncemented THA for primary osteoarthritis (OA) in patients under 55 years of age and the factors affecting survival. ⋯ Modern second-generation uncemented stems, with proximal circumferential porous- or HA-coating, seem to be a good choice for young patients with primary OA. Similarly, modern press-fit porous- and HA-coated cups appear to have good endurance against aseptic loosening in these young patients. However, liner revisions were common; thus, survival rates of uncemented cups were unsatisfactorily low. Polyethylene wear and unfavorable locking mechanisms between the metal shell and the polyethylene liner and their sequelae remain matters of concern in this young and active group of patients.
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It is unclear whether the prevalence of chronic low back pain is higher in chronic whiplash patients than in the general population. In a population-based study, we evaluated the prevalence of chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin, with special emphasis on whiplash injury. ⋯ Independently of traumatic or non-traumatic origin of the symptoms, the prevalence of chronic low back pain is 3 times higher in individuals with chronic neck pain than in the general population. Causes other than a history of neck trauma, such as chronic muskuloskeletal pain syndromes, may be important in evaluation of these cases.
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The use of massive bone allografts in cases of revision of failed total hip arthroplasties (THAs) due to infection is controversial. ⋯ Our results support the use of massive allografts in staged reconstructions of infected THAs complicated by considerable bone loss.
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Vascularized soft tissue transfer may give better results of treatment of infected nonunions of the tibia. ⋯ Staged reconstruction with free vascularized soft tissue transfer and conventional bone grafting within a cement-induced membrane is a low-risk surgical strategy resulting in a high rate of bone healing.
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Randomized Controlled Trial
Tranexamic acid reduces blood loss in cemented hip arthroplasty: a randomized, double-blind study of 39 patients with osteoarthritis.
Tranexamic acid has been found to reduce blood loss and the need for blood transfusions in knee arthroplasty. In hip arthroplasty, the benefit of tranexamic acid is not as clear. ⋯ Total blood loss was smaller in the tranexamic acid group than in the control group. No thromboembolic complications were noticed. Tranexamic acid appears to be an effective and economic drug for reduction of blood loss in cemented primary hip arthroplasty for osteoarthritis.