Journal of surgical orthopaedic advances
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Revision total knee arthroplasty (TKA) often requires long diaphyseal supporting stems. Pain at the end of the cemented revision stem has been reported, but no study has been published regarding the incidence in cementless revision TKA. This study reviewed 120 cementless revision TKAs with a diaphyseal slotted stem to compare the incidence of stem pain to that in a control cohort of 100 primary TKA patients with a metaphyseal stem. ⋯ In the primary TKA cohort, seven out of 100 patients reported pain below the tibial stem. No correlation between stem length or stem fit was found. This study found that more than 16% of patients may have pain at the end of their press-fit revision TKA stem, and this complication should be explained to patients before their revision TKA surgery.
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Case Reports
Use of a Fascial Flap to Stabilize an Unstable Ulnar Nerve in Its Bed During In Situ Decompression.
This case report involves a man with ulnar neuropathy at the elbow, who was to undergo an in situ decompression of the ulnar nerve. When the nerve was noted intraoperatively to sublux partially over the posterior portion of the medial epicondyle, the surgeon stabilized the nerve in situ by using a fascial flap that was secured to the anterior rim of the cubital tunnel and loosely sutured posteriorly to the medial side of the olecranon, rather than performing an anterior transposition or medial epicondylectomy. This method could be considered a middle-ground surgical technique because it allowed the nerve to remain in its bed, did not disturb its blood supply, dealt with the problem of a slightly unstable ulnar nerve with a fascial flap, and avoided methods that could be considered as having greater surgical magnitude.
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Factors associated with successful selection in U. S. Army orthopaedic surgical programs are unreported. ⋯ PDs made no discriminations based on allopathic or osteopathic degrees. The most important factors for Army orthopaedic surgery residency selection were clerkship performance at the individual PD's institution and licensing examination score performance. Army PDs consider both USMLE and COMLEX results, because Army programs have a higher percentage of successful osteopathic applicants.
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Insufficient control of pain after total hip arthroplasty (THA) can delay rehabilitation and adversely affect long-term surgical outcomes. The current study directly compares 36 THA patients who were given a routine wound infiltration (RWI group) with 36 patients who were administered an injection of liposomal bupivacaine infiltration (LBUP group). ⋯ The average number of opioid doses was 13.14 for the RWI group compared with 4.97 for the LBUP group (p < .0001), and the total opioid dosage consumed was greater in the RWI group (105.4 vs. 72.3, p = .0075; significant only in regression model). The results of this study support the conclusion that liposomal bupivacaine infiltration, as part of a multimodal program after THA, can improve postoperative analgesia and reduce opioid consumption when compared with routine wound infiltration.
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There is a known bleeding risk with administration of the antiplatelet drug clopidogrel, but in certain patients the likelihood of thrombosis is too high to cease its administration perioperatively. The risks of performing total joint arthroplasty in this population are unknown. An inpatient pharmacy database query identified seven patients who underwent eight hip or knee arthroplasties from 2007 to 2009 without perioperative interruption in clopidogrel administration. ⋯ The majority of bleeding-related events occurred following knee arthroplasty. Uninterrupted perioperative clopidogrel administration was associated with a high risk of bleeding-related events following total joint arthroplasty, particularly of the knee. Consideration should be given to delaying total joint arthroplasty until clopidogrel can safely be held in the perioperative period.