Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 1997
Review Comparative StudySimultaneous bilateral versus unilateral total knee arthroplasty. Outcomes analysis.
One hundred consecutive, primary simultaneous bilateral total knee arthroplasties were prospectively compared with 100 consecutive, primary unilateral total knee arthroplasties in reference to relative risk, complications, cost, and need for rehabilitation. All procedures were performed using identical preoperative, intraoperative, and postoperative protocols. Postoperative confusion was approximately four times greater in the simultaneous bilateral total knee arthroplasties group (29% versus 7%), which was thought to represent an increased incidence of fat embolism. ⋯ Total rehabilitation charges were similar. The relative cost savings implicit by doing simultaneous bilateral total knee arthroplasties seem to be at least partially offset by the approximately two times greater need for rehabilitation in this group. The true safety, efficacy, relative risk, and total cost analysis of simultaneous bilateral total knee arthroplasties demands further critical evaluation.
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Clin. Orthop. Relat. Res. · Dec 1997
Comparative StudyOutcome of hip and knee arthroplasty in persons aged 80 years and older.
Recent studies have established the cost effectiveness and safety of total joint arthroplasties. As the population ages, it is important to determine whether these procedures are equally beneficial in the elderly. The short term safety and efficacy of total hip and knee arthroplasties in subjects 80 years of age and older was evaluated. ⋯ The most dramatic postoperative functional gains were seen in the most disabled subjects. Total charges of care for patients 80 years of age and older was slightly greater than for a younger group. It was established that total joint arthroplasty can be performed safely in patients 80 years of age and older, promising excellent pain relief and improved functional outcome.
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The sequential course of the knee score and functional score of the Knee Society rating system of 276 press fit condylar modular unconstrained total knee arthroplasties performed for osteoarthritis between June 1988 and December 1992 was documented prospectively. The knee score increased significantly and stayed on a constant level from 2 years on, whereas the function score reached a maximum at 2 years and declined subsequently. Multiple regression analysis was performed testing the statistical significance and correlation of preoperative predictors with criteria at followup to determine their influence on outcome. ⋯ Their impact on the overall result can be controlled by separate rating of the knee score and function score as the dual Knee Society rating system does. Scoring systems adding up knee and functional rating to an overall result should not be used. There is a need for additional improvement of total knee arthroplasty rating such as patient based evaluation and establishing reliability and validity.
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Clin. Orthop. Relat. Res. · Dec 1997
Outcome implications for the timing of bilateral total knee arthroplasties.
Health Care Financing Administration data from 1985 to 1990 revealed 339,152 total knee arthroplasties of which 62,730 (18.6%) were bilateral procedures (simultaneous 112,922; staged 6 weeks, 4354; staged 3 months, 4524; staged 6 months, 9829; and staged 1 year 31,401). Medicare beneficiaries undergoing bilateral procedures were an average of 73 years of age; demographics revealed that among the various simultaneous and staged groups 57% to 69% were females, 90% were white, 85% to 90% had a diagnosis of osteoarthritis, and 30% to 40% were performed in rural hospitals. Between 1985 and 1990, surgical and vascular complications ranged from 2.4% to 4% and 4.1% to 6.8%, respectively, for all types of bilateral staged and simultaneous total knee arthroplasties. ⋯ Length of stay and cost were much less for the simultaneous procedure group who were sicker as measured by the number of diagnoses. Mortality at 30 days was highest for the simultaneous procedure group (.99%) versus staged 3 or 6 months (0.30%); however, by 2 years it was close to 4% for all groups. Staging the procedure 3 to 6 months seems to offer the fewest disadvantages, is only slightly more expensive, and has the lowest mortality rate.
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Clin. Orthop. Relat. Res. · Dec 1997
Anatomy of the posterior interosseous nerve in relation to fixation of the radial head.
The relationship of the posterior interosseous nerve to the radial neck as it relates to internal fixation of radial head fractures was studied in 50 fresh anatomic specimen arms. After a standard posterolateral approach, blind subperiosteal dissection was performed distally until a 4-cm minifragment plate could be placed on the shaft of the radius. Dissection of the radial nerve was performed under loupe magnification. ⋯ The muscular branch to the extensor carpi radialis longus was located 7.1 +/- 1.8 mm from the radial head. These findings suggest that pronation of the forearm with blind subperiosteal dissection for plate placement does not place the posterior interosseous nerve at significant risk for structural injury. However, as with any approach done in the region of the nerve, caution should be used to avoid tension on the nerve that could lead to physiologic injury.