The Journal of arthroplasty
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Tibial tubercle osteotomy (TTO) is a recognized technique for improving exposure when performing total knee arthroplasty surgery. Forty-two patients were reviewed at a mean of 8 years after TTO. Preoperatively, mean extension was 8 degrees +/- 14 degrees , mean flexion 74 degrees +/- 30 degrees , and Knee Society score 73 +/- 37. ⋯ Twenty-five percent of patients experienced no extensor lag, and 66% of extensor lags had resolved within 6 months. Mean time for osteotomy union was 14 weeks. In this series, TTO performed to enhance surgical exposure did not adversely affect the outcome after total knee arthroplasty but resulted in serious complications in 5% of patients.
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Case Reports
Involvement of the lateral femoral cutaneous nerve as source of persistent pain after total hip arthroplasty.
This report describes a situation in which the lateral femoral cutaneous (LFC) nerve was the source of incisional pain in a patient after a total hip arthroplasty. The painful scar was denervated by an approach that resected just the posterior branch of the LFC nerve. ⋯ One of the 3 patients reported here had a coexisting meralgia paresthetica that was treated by the same operative approach. The orthopedic surgeon should include the LFC nerve as an origin of persistent pain after total hip arthroplasty.
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Our purpose was to estimate the incidence of unicompartmental knee arthroplasty in the United States. Three major implant manufacturers provided data over an 8-year period from 1998 to 2005. ⋯ Unicompartmental knee arthroplasty increased at an average rate of 32.5% during the study period compared with a 9.4% average increase in rate of total knee arthroplasty over the same period. Although unicompartmental arthroplasty is growing at triple the rate of total knee arthroplasty in the United States, the data suggest that unicompartmental implants currently account for less than 8% of all knee arthroplasty procedures.
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Comparative Study
Effect of anesthesia type on limb length discrepancy after total hip arthroplasty.
A retrospective study of 132 patients (63 spinal anesthesia and 69 general anesthesia) undergoing total hip arthroplasty was performed by 4 fellowship-trained adult reconstructive surgeons to determine the influence of anesthesia type on postoperative limb length and medial offset. Limb length discrepancy occurred in 87.0% of patients who received regional anesthesia as opposed to 47.6% patients who had general anesthesia (P<.001). Differences in postoperative medial offset measurements between the 2 groups were not statistically significant. It was concluded that surgeons operating on patients who receive regional anesthesia should supplement intraoperative tests for assessing hip stability with meticulous preoperative templating to avoid overlengthening the operative limb.
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This study seeks to evaluate the clinical outcomes of a second primary total knee arthroplasty in patients whose initial (contralateral) primary total knee arthroplasty was complicated by stiffness. We retrospectively compared the preoperative and postoperative range of motion and Knee Society Scores from a study group of 15 patients with an age-matched control group. ⋯ However, there was a statistically significant higher rate of closed manipulation in the study group. Therefore, although the study group did show a higher rate of early stiffness, eventual functional outcome was comparable with a nonstiffness control group.