The Journal of arthroplasty
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Case Reports
A custom coupling device of total knee and ipsilateral total hip arthroplasties after distal femoral fracture.
The treatment of periprosthetic femoral fractures around long-stemmed hip implants is an orthopedic challenge, which may be complicated by the presence or need for a total knee arthroplasty. Treatment of this fracture when the proximal implant is well fixed and a distal implant is required poses ongoing challenges. Traditional plating and allograft struts have produced variable results, particularly in osteoporotic bone, where incidence of nonunion is greater. Thus, we report a custom interlocking device, which couples the stem of the fixed proximal implant to a new stemmed total knee prosthesis, resulting in the expedited restoration of functionality and fracture union.
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A magnetic resonance imaging study of 50 Chinese normal knees was conducted to determine the knee joint line position. The distances from the fibular head and the tibial tubercle to the joint line were measured, and each distance value was converted to a ratio relative to the anteroposterior tibial widths at the levels of the insertion of the patellar tendon and the apex of the fibular head. ⋯ The fibular head and tibial tubercle are reliable landmarks. The distances and ratios can be used to determine the knee joint line position in revision surgery for the Chinese population.
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Randomized Controlled Trial
Is intra-articular multimodal drug injection effective in pain management after total knee arthroplasty? A randomized, double-blinded, prospective study.
We performed a prospective, double-blinded, randomized, and controlled study to assess the clinical efficacy and safety of intra-articular multimodal drug injection after total knee arthroplasty. Two hundred eighty-six patients undergoing simultaneous bilateral total knee arthroplasty were randomized to receive the injection of multimodal drugs in one knee and normal saline solution as a placebo in the contralateral knee. ⋯ The range of motion and blood loss were also recorded. Intraoperative intra-articular injection of multimodal drugs into the knee did not improve patient pain and satisfaction, range of motion, or blood loss compared with the placebo control.
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Randomized Controlled Trial
Benefits of prolonged postoperative cyclooxygenase-2 inhibitor administration on total knee arthroplasty recovery: a double-blind, placebo-controlled study.
A double-blind, placebo-controlled study of a selective cyclooxygenase (COX)-2 inhibitor administered in 107 patients for 6 weeks after total knee arthroplasty was done to determine any benefits. All patients received celecoxib preoperatively and during hospitalization. At hospital discharge, patients were randomized to receive celecoxib or placebo for 6 weeks. ⋯ The celecoxib group used fewer narcotics and had significantly better visual analog scale scores, knee flexion, Knee Society Score scores, Oxford Knee Score scores, and Short-Form 12 physical composite scores than the placebo group. Knee flexion remained significantly improved through 1 year. These results demonstrate that patients who took celecoxib for 6 weeks after total knee arthroplasty had a less painful and more rapid recovery.
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There are currently few published studies examining the use of locking compression plates for the treatment of periprosthetic femoral fractures. Fifteen total hip or knee arthroplasty patients with 16 Vancouver type B1 and C fractures with an average age of 76 years were fixed and followed clinically and radiographically for 2 years. Fourteen patients achieved radiographic union by 6 months, and 13 patients were ambulatory by 6 months. ⋯ In summary, locking plates offer a viable treatment option for these difficult fractures. We advocate a minimum of 10 cortices of fixation (with unicortical or bicortical screws and cable combinations) above and below the fracture. Bone grafting should be used if the soft tissue envelope is violated with extensive dissection, and cortical struts should be considered in cases of failed hardware and revision fixation.