Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · May 2015
ReviewStatic progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients.
The elbow is prone to stiffness after trauma. To regain functional elbow motion, several conservative and surgical treatment options are available. Nonoperative treatment includes physical therapy, intra-articular injections with corticosteroids, and a static progressive or dynamic splinting program. The objective of this study was to perform a comprehensive review of the literature to evaluate the best current evidence for nonoperative treatment options for posttraumatic elbow stiffness. ⋯ Both dynamic orthoses and static progressive splinting show good results for the treatment of elbow stiffness, regardless of etiology. The choice for one treatment over the other is based on the preference of the surgeon and patient. We recommend to continue nonoperative treatment with dynamic or static bracing for 12 months or until patients stop making progression in range of elbow motion.
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Arch Orthop Trauma Surg · May 2015
Randomized Controlled TrialNo need for use of drainage after minimally invasive unicompartmental knee arthroplasty: a prospective randomized, controlled trial.
Drainage is a common procedure in unicompartmental knee arthroplasty (UKA), but evidence regarding its effectiveness is lacking. The aim of this study was to investigate the benefits of drainage after minimally invasive UKA with effective blood loss management. ⋯ The use of drainage in unilateral UKA provides no apparent advantage. With effective blood loss management and a minimally invasive procedure, blood loss and drainage volume in UKA are very low. Drainage does not improve the results. Foregoing non-drainage after UKA reduces both hospital costs and visible blood loss. Therefore, drainage is unnecessary in routine UKA.
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Arch Orthop Trauma Surg · May 2015
Semiconstrained total elbow arthroplasty for rheumatoid arthritis patients: clinical and radiological results of 1-8 years follow-up.
We investigated whether the Discovery total elbow arthroplasty (TEA) system had good results and survival in rheumatoid arthritis (RA) patients. ⋯ The Discovery system has shown satisfactory results in RA patients even if the rate of complication remained relatively high. Further follow-up is required to investigate the radiological changes observed in some of our patients.
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Osteolysis and aseptic loosening currently contribute 75 % of implant failures. Furthermore, with over four million joint replacements projected to be performed in the United States annually, osteolysis and aseptic loosening may continue to pose a significant morbidity. This paper reviews the osteolysis cascade leading to osteoclast activation and bone resorption at the biochemical level. ⋯ A non-surgical treatment of osteolysis has not been found in the literature and thus may become an area of future research. Even though this research is warranted, comprehensively understanding the immune response to orthopedic implants and their metallic ions, and thus, creating improved prostheses appears to be the most cost-effective approach to decrease the morbidity related to osteolysis and to design implants with greater longevity. The ionic forms, cytokines, toxicity, gene expression, biological effects, and hypersensitivity responses of metallic elements from metal implants are summarized as well.