Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 1999
Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty.
Obtaining predictable, stable fixation of revision femoral implants is important for the long-term success of revision hip arthroplasty. The authors report on minimum 10 years clinical and radiographic followup of 170 patients with extensively coated cementless revision femoral components. With a range of followup of 10 to 16 years and a mean of 13.2 years, a survivorship of greater than 95% was reported. ⋯ Stress shielding was greatest in patients with stems larger than 16.5 mm and in osteoporotic bone (Dorr Type C). Nine percent of patients had significant thigh pain including all of the patients with unstable stems. In the presence of bone loss in the proximal metaphyseal region of the femur, fixation of the femoral component is predictable when optimizing prosthetic-bone fit in the diaphyseal region of the femur using an extensively coated femoral component.
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Sepsis after total joint replacement is related directly to environmental contamination. Therefore, to control the source of environmental contamination, and ultimately sepsis, it must be realized that the operating room personnel are the major source of the bacteria as evidence by the rise in the colony forming units per square foot per hour from 13 units in an operating room without people to greater than 400 units during actual surgery. The use of inclusive gowns, such as hooded body exhaust, is most helpful. ⋯ Face masks and head covers offer no environmental protection. Some type of an environmental control, such as laminar airflow or ultraviolet light, is the most helpful with greater than 90% reduction of airborne bacteria at the wound and 60% reduction of airborne bacteria in the operating room. Therefore, to reduce environmental bacteria contamination the number of personnel in the operating room and the length of time for the actual surgery should be reduced, because wound contamination occurs first by direct fall out from the environment and second by contaminated equipment and gloved hands that initially were contaminated by the environment.
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Clin. Orthop. Relat. Res. · Dec 1999
Primary and revision total hip replacement in patients who are Jehovah's Witnesses.
The Jehovah's Witnesses do not accept allogeneic blood transfusion or certain types of autologous blood transfusion and, therefore, present the orthopaedic surgeon with a challenge in the management of perioperative blood loss. Accepting a patient who is a Jehovah's Witness as a surgical candidate requires the surgeon to be prepared medically to use known techniques to limit red blood cell loss or increase red blood cell mass, to resort to extraordinary means when necessary, and to be prepared philosophically to deal with catastrophic blood loss in a patient who may refuse even potentially life-saving transfusion. Issues pertinent to the management of intraoperative blood loss in the patient who is a Jehovah's Witness require careful delineation and specific treatment guidelines. The authors herein review their past and current experiences in the perioperative blood management of this patient population in an attempt to address this need.
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Clin. Orthop. Relat. Res. · Dec 1999
Analgesia with femoral nerve block for anterior cruciate ligament reconstruction.
Anterior cruciate ligament reconstruction is performed routinely as an outpatient surgical procedure despite few studies of patient acceptance or postoperative patient analgesia. This study reports the first series of postoperative femoral nerve blocks as analgesia for outpatient anterior cruciate ligament reconstruction. The authors retrospectively reviewed 161 patients undergoing two incision arthroscopically assisted autograft middle 1/3 patellar tendon anterior cruciate ligament reconstruction on an out-patient basis at the authors' institution during a period of 30 months. ⋯ However, 69% of patients staying overnight cited reasons other than pain as factors in their stay. No significant complications were reported. Based on these results, the administration of a femoral nerve block is recommended for patients undergoing outpatient anterior cruciate ligament reconstruction because it is a highly effective form of analgesia with an excellent degree of patient satisfaction.
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Clin. Orthop. Relat. Res. · Dec 1999
Comparative StudyEnd-to-side anastomosis of transected nerves to prevent neuroma formation.
Neuroma can be painful and physically and psychologically disabling. Among the many methods of treatment available, one of the more successful is centrocentral nerve union with an autologous graft. However, it cannot be used in small nerves that lack two fascicles. ⋯ The myelinated fibers were 2 to 10 microns in diameters and had a normal appearance with thin myelin sheaths. End-to-side anastomosis formed a smaller mass of regenerated nerve tissues. Ultrastructurally they were formed better and orientated more orderly resembling normal nerve.