International orthopaedics
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Comparative Study
Novel strategies to improve early outcomes following total knee arthroplasty: a case control study of intra articular injection versus femoral nerve block.
The incidence of total joint arthroplasty is rapidly increasing. As costs are rising as well, orthopaedic surgeons are now being called on to demonstrate the value of our procedures. We recently evaluated a new technique of local injection in total knee arthroplasty (TKA) as a potential means to improve quality and decrease costs. ⋯ Local injection in TKA with liposomal bupivicaine appears to be a useful tool in adding value to patient care. This technique was shown to improve patient outcomes while simultaneously decreasing costs.
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Management of the unexplained, painful large diameter metal-on-metal (MOM) hip replacement is difficult. Although there are guidelines for surgeons, there is no clear documented evidence describing the overall threshold for revision surgery. The 2010 product recall of the DePuy Articular Surface Replacement (ASR) and subsequent media coverage may have increased patient and surgeon apprehension, resulting in earlier intervention, i.e. at a greater Oxford hip score (OHS) than expected. Our aim was to investigate whether the threshold for revision using known parameters was affected by the ASR recall. These parameters include poor clinical results (persistent pain or mechanical symptoms), pseudotumour or other progressive soft tissue involvement, osteolysis and high or rising metal ion levels. ⋯ Issue of a product recall did not change the hip function threshold for revision surgery. The decision to revise a metal-on-metal hip is complex and should follow published guidelines, encompassing metal ion measurement and cross-sectional imaging where appropriate.
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Interprosthetic fractures are challenging to manage. Although treatment of femoral fractures around a single implant has been described, there is little literature for treatment of interprosthetic femoral fractures. This study analyses the management and outcomes of 15 patients with interprosthetic femoral fractures treated with locking plates. ⋯ Locking plates could achieve satisfactory results for interprosthetic fractures. Considering an individual's fracture type, bone quality and protheses to determine the appropriate plate length and optional use of cerclage and/or bone graft was essential. In this limited sample size, interprosthetic fractures occurred at similar rates at the supracondylar region and diaphysis.
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The Kashmir earthquake, also known as the South Asia earthquake, hit Jammu and Kashmir (India) on 8th October 2005 (registered as 7.6 on Richter scale) and was quite devastating, with the official toll being 1,360 (some estimates being around 1,800). The injured registered around 6,300. In such an enormous disaster, rescue operations, relief and rehabilitation is a great challenge. One week after the Kashmir earthquake (2005), a multidisciplinary rehabilitation team headed by the corresponding author went to Srinagar (Kashmir). The purpose was to tackle the medical rehabilitation issues of the victims of the earthquake and later study the epidemiology of various injuries, especially the spinal injuries, so as to improve the future rehabilitation strategies in similar scenarios. ⋯ In a massive natural calamity like the Kashmir (India) earthquake of 2005, a collective effort by a rehabilitation team for providing supportive/assistive devices along with physiotherapy and psychotherapy has significantly helped in recovery of functional and psychological status of the spinal trauma victims. No doubt that the life saving operations and definitive surgery are important to combat major catastrophe in such disasters but early medical rehabilitation is equally important to reduce injury-related disability.
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Comparative Study
Bone union rate with recombinant human bone morphogenic protein-2 versus autologous iliac bone in PEEK cages for anterior lumbar interbody fusion.
Autologous iliac crest bone graft (ICBG) is the gold standard material for spinal fusion. Bone graft substitutes, such as recombinant human bone morphogenic protein 2 (rhBMP-2) have been developed to promote spinal fusion and address morbidity issues related to ICBG harvesting. The objective of this study was to compare bone fusion rates after anterior lumbar interbody fusion (ALIF) between ICBG and rhBMP-2 by examining thin-cut computed tomography (CT) images at the one year follow-up. ⋯ RhBMP-2 was inferior to ICBG in terms of rate and quality of bone fusion in one- or two-level ALIF.