The Journal of arthroplasty
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Modular femoral necks in total hip arthroplasty are promoted as giving the surgeon more options during surgery and as being safe. We report a case of fatigue fracture in the modular neck of a femoral implant 3 1/2 years after implantation. The probable design errors leading to product failure are discussed.
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The increasing number of total knee arthroplasties implies a greater likelihood of periprosthetic fractures and need for successful treatment options. We report a case where in situ effective lengthening of the stem of a well-fixed indwelling prosthesis by a custom-made intramedullary nail with taper-lock coupling provided a successful alternative to the established internal fixation techniques involving prosthesis exchange. We believe that effective lengthening of indwelling prosthesis by a custom-made intramedullary nail is an effective option for treating periprosthetic femoral fractures in selected cases, where an attempt of removing well-fixed implant would result in unacceptable bone loss at the joint level.
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Randomized Controlled Trial
Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty:a prospective, randomized trial.
We evaluated the efficacy of periarticular infiltration of corticosteroid, opioid, and a local anesthetic by comparing pain scores, knee flexion, and quadriceps function on the day of surgery, first postoperative day, day of discharge, and 2 and 4 weeks after surgery between the infiltrated and the noninfiltrated knee in 40 patients undergoing simultaneous bilateral computer-assisted total knee arthroplasty who were randomized to receive the injection in the right or left knee. In comparison to the noninfiltrated side, the infiltrated knee showed significantly lower pain scores, significantly greater active flexion up to 4 weeks, and superior quadriceps recovery up to 2 weeks after surgery. This simple and inexpensive technique can significantly reduce pain and hasten functional recovery in the first month after total knee arthroplasty.
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Obstructive sleep apnea (OSA) may be a risk factor for complications after total joint arthroplasty (TJA). We sought to determine the prevalence of OSA in patients undergoing TJA, and the safety and effectiveness of intrathecal narcotic (IN) in these patients. We retrospectively reviewed 1255 consecutive patients undergoing 1463 TJA at one hospital. ⋯ Compared with 127 randomly selected patients (141 TJA) without OSA, OSA patients were significantly heavier and had higher American Society of Anesthesiologists scores, more comorbidities, longer length of stay, more transient hypoxia, more transfusions, and more medical variances. Despite more minor variances, with appropriate screening and management, OSA patients did not have a higher rate of significant or major complications. Length of stay, although longer, was only 2.3 days in OSA patients, demonstrating the safety and efficacy of IN anesthesia in these patients.
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The purpose of this study was to evaluate the stiffness of 3 different constructs for the fixation of comminuted Vancouver B1 periprosthetic femoral shaft fractures: a single lateral locking plate, a single lateral locking plate plus an anterior strut allograft, and a lateral locking plate plus an anterior locking plate. The axial stiffness, lateral bending stiffness, and torsional stiffness of 10 synthetic periprosthetic femur fracture models were tested. ⋯ Fixation technique was found to have a significant effect for all loading modalities (P < .0001). A lateral locked plate plus an anterior locked plate was significantly stiffer than the allograft that in turn was significantly stiffer than the single plate (P < .0001).