Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2018
ReviewPorous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature.
Revision knee arthroplasty is increasing, and in that case, bone loss management is still a challenging problem. In the last years, the body of literature and interest surrounding porous metal cones has grown, but few systematic evaluations of the existing evidence have been performed. The aim of our systematic review is to collect and critically analyze the available evidence about metal cones in revision knee arthroplasty especially focusing our attention on indications, results, complications, and infection rate of these promising orthopaedic devices. ⋯ The examined studies provide encouraging clinical and radiological short-to-mid-term outcomes. Clinical studies have shown a low rate of aseptic loosening, intraoperative fractures, infection rate and a lower failure rate than the previous treatment methods. Higher quality papers are needed to draw definitive conclusions about porous metal cones.
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Arch Orthop Trauma Surg · Jun 2018
Multicenter StudyNon-prosthetic peri-implant fractures: classification, management and outcomes.
Non-prosthetic peri-implant fractures (NPPIFs) are an under-reported entity. Management is challenging because of alterations in anatomy, the presence of orthopaedic implants and phenomena such as stress shielding, disuse osteopenia and fracture remodeling. The aims of this paper were to review patterns of injury, management and outcomes and to propose a classification system to aid further research. ⋯ Therapeutic Level IV-case series.
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Arch Orthop Trauma Surg · Jun 2018
Preoperative PCR analysis of synovial fluid has limited value for the diagnosis of periprosthetic joint infections of total knee arthroplasties.
Preoperative diagnosis of periprosthetic joint infection (PJI) is important because of the therapeutic consequences. This prospective study was designed to answer the question, if preoperative PCR analysis of the synovial fluid in addition to the culture and the CRP analysis of the blood are helpful for the diagnosis of PJI in knee arthroplasties. Before revision CRP analysis of the blood, cultivation and PCR analysis of synovial fluid of 116 knee endoprostheses were performed. ⋯ The PCR analysis of the synovial fluid resulted in a sensitivity of 55.6%, a specificity of 82.0%, a positive-predictive value of 48.4%, a negative-predictive value of 85.9% and an accuracy of 75.9%. The sensitivity for culture of the aspirate and PCR analysis in combination with an elevated CRP level was 85.2%, the specificity 82.0%, the positive-predictive value 58.9%, the negative-predictive value 94.8% and the accuracy 82.7%. The preoperative PCR analysis of synovial fluid has only limited value in addition to the standard culture analysis.
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Arch Orthop Trauma Surg · Jun 2018
Quantifying shortening of the fractured clavicle assuming clavicular symmetry is unreliable.
One of the more commonly used methods of determining the amount of shortening of the fractured clavicle is by comparing the length of the fractured side to the length of contralateral unfractured clavicle. A pre-existing natural asymmetry can make quantification of shortening using this method unreliable. The goal of this study is to assess the side-to-side variation in clavicle length in 100 uninjured, skeletally mature adults. ⋯ 2.