The Journal of arthroplasty
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Bone defects in total hip arthroplasty revision surgery can be restored with different types of bone graft. The use of impacted morselized allograft chips in combination with cement is the treatment of our choice. To establish the incorporation capacity of the grafts and mechanical stability of the implant, an animal model in the goat was developed. ⋯ Thereafter, the stability decreased, probably by soft-tissue interface formation at the graft cement interface. We conclude that cemented morselized allografts have a high capacity to incorporate. Initial cup stability is adequate to provoke graft incorporation with decreasing stability after the incorporation process has been completed.
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This study evaluates the impact of a clinical pathway (CP) and a hip implant standardization program (HISP) on the quality and cost of total hip arthroplasty (THA). Two hundred six unilateral THA operations for osteoarthritis were evaluated: 89 operations were performed in 1991 without a CP or HISP (4-year follow-up period); 117 operations were performed in 1993 with a CP and HISP (2-year follow-up period). ⋯ No differences were seen between groups in terms of patient ratings of outcome and satisfaction or in terms of complication rates in the hospital. Implementation of a CP and HISP did not adversely affect the short-term outcome of THA but did reduce hospital length of stay and hospital cost for THA.
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Comparative Study
Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty.
A hospital-based computer system was used to compare the inpatient costs of performing bilateral simultaneous sequential, staged, and unilateral total hip and knee arthroplasties. Bilateral simultaneous sequential total knee arthroplasty was 36% less costly than 2 unilateral total knee arthroplasties. ⋯ There was a significant correlation between hospital length of stay, morbidity, and total costs, but no correlation with patient age and sex except in the unilateral knee patients. Bilateral simultaneous sequential joint arthroplasty can save more than $10,000 for each total knee patient and more than $8,000 for each total hip patient.
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Randomized Controlled Trial Comparative Study Clinical Trial
Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty.
Thigh pain following tourniquet application is a common patient complaint in the early postoperative period following total knee arthroplasty. Postoperative thigh pain was evaluated in 28 consecutive simultaneous bilateral total knee arthroplasty patients between April 1996 and October 1996. A prospective, double-blind, randomized clinical trial was performed. ⋯ At 6 weeks after surgery, the difference in thigh pain was gone. For total knee arthroplasty, using the tourniquet at a pressure of 100 mmHg above the systolic blood pressure is recommended. This is adequate to provide a bloodless field and will result in a less unpleasant postoperative period.
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Case Reports
Progressive bilateral pelvic osteolysis in a patient with McKee-Farrar metal-metal total hip prostheses.
As accumulating evidence indicates that polyethylene plays a central role in periprosthetic osteolysis, there is a renewed interest in alternatives such as metal-metal bearings. Several long-term studies report encouraging results with the McKee-Farrar total hip arthroplasty, but there is a paucity of data on the incidence, severity, and pathogenesis of osteolysis in metal-metal bearing total hip arthroplasties. This study presents a patient who had progressive bilateral pelvic osteolysis associated with his McKee-Farrar metal-metal total hip prostheses. ⋯ When bone becomes part of the effective joint space, it is exposed to particulate debris, soluble factors, and potentially increased joint fluid pressures, which may promote localized bone resorption. It must be kept in mind that the development of osteolysis is multifactorial. Although bearings with better wear characteristics are desirable, the elimination of polyethylene will not eliminate osteolysis.