Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2006
Comparative StudyIntraoperative electron radiotherapy for extremity sarcomas does not increase acute or late morbidity.
Intraoperative electron radiotherapy is used to treat surgical sites that potentially harbor occult tumor immediately after limb-sparing surgical resection of extremity soft tissue sarcomas. It is unknown whether single-fraction, high-dose intraoperative electron radiotherapy at the time of surgery increases wound morbidity when combined with preoperative or postoperative external beam radiotherapy. In a retrospective study, we evaluated whether intraoperative electron radiotherapy increased 90-day and late (> 90 days) wound complication rates by comparing patients who had adult extremity soft tissue sarcomas treated by limb-sparing surgery and preoperative (n = 14) or postoperative (n = 13) external beam radiotherapy. The median followup was 36 months. Seven (26%) patients had wound complications occurring within 90 days postoperatively and completion of radiotherapy. Late wound complication rates were similar. Two patients in each of the external beam radiotherapy groups required late subtotal limb amputations for prolonged wound complications. Our findings suggest intraoperative electron radiotherapy during limb-sparing surgery allows radiation dose escalation without increased 90-day or late-wound complication rates when combined with preoperative or postoperative external beam radiotherapy for patients with extremity soft tissue sarcomas. ⋯ Prognostic Study, Level II (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2006
Comparative StudyRevision total knee arthroplasty does not increase PACU utilization.
The hospital records of 232 consecutive cases of patients undergoing primary and revision total knee arthroplasty were analyzed to determine differences in operating room time, postanesthesia care unit time, operating room narcotic usage, and postanesthesia care unit narcotic usage between the two groups. The average operating room time for a surgeon performing revision total knee arthroplasty on a patient was greater than that for a primary total knee arthroplasty. However, there was no difference in average postanesthesia care unit time nor operating room and postanesthesia care unit narcotic usage. When stratified to anesthetic type and perioperative pain intervention, there was no difference in any of the measured parameters between the primary and revision groups. Thus, even with longer operating times, a patient undergoing revision total knee arthroplasty did not utilize more postanesthesia care unit time, nor more perioperative narcotics, than a patient undergoing primary total knee arthroplasty. ⋯ Therapeutic study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.