Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Nov 2003
Predicting total knee replacement pain: a prospective, observational study.
To describe the natural history of pain after total knee arthroplasty and to identify factors predicting excessive postoperative pain, we used a prospective, observational study assessing clinical and radiographic variables preoperatively and at 1, 3, 6, and 12 months after knee replacement. Data sources included the visual analog pain scale and other measures of patient health, psychologic state, and component reliability. Regression analyses were conducted to identify specific factors predictive of postoperative pain, controlling for inequality of variables, and confirmed using regression diagnostics. ⋯ Pain after knee replacement resolves quickly, declining to approximately (1/2) by 3 months. However, one in eight patients report moderate to severe pain 1 year after surgery despite an absence of clinical or radiographic abnormalities. Development of office-based preoperative screening tools and interventions for these patients may reduce postoperative costs and improve patient-perceived outcomes.
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Clin. Orthop. Relat. Res. · Nov 2003
Comparative StudyStem fixation in revision total knee arthroplasty: a comparative analysis.
Methods of stem fixation are a controversial aspect of revision TKA. We sought to determine which technique was superior by reviewing 475 revision TKAs done between 1986 and 2000. Of these 475 revisions, 286 major component revisions were done using 484 extended stems for fixation. ⋯ Of the 95 implants placed with cementless stems, only 67 (71%) were categorized as stable. Eighteen (19%) were possibly loose requiring close followup and 10 (10%) were loose (two tibial and eight femoral implants). We currently would urge caution in using cementless metaphyseal engaging stems for fixation in revision TKA.
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Scapulothoracic dissociation is an important and increasingly common clinical condition resulting from massive traction injury to the anterolateral shoulder girdle with disruption of scapulothoracic articulation. It frequently is accompanied by an acromioclavicular separation, displaced clavicular fracture, or sternoclavicular disruption. ⋯ Many patients have a poor outcome with a flail extremity in 52%, early amputation in 21%, and death in 10%. Early recognition of this injury combined with a logical treatment protocol can help to decrease the substantial morbidity and mortality associated with this condition.