Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 2008
Small increase of actual physical activity 6 months after total hip or knee arthroplasty.
Limitation in daily physical activity is one of the reasons for total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning. We determined the effect of THA or TKA on patients' actual physical activity and body function (pain, stiffness), capacity to perform tasks, and self-reported physical functioning. We also assessed whether there are differences in the effect of the surgery between patients undergoing THA or TKA and whether the improvements vary between these different outcome measures. We recruited patients with long-standing end-stage osteoarthritis of the hip or knee awaiting THA or TKA. Measurements were performed before surgery and 3 and 6 months after surgery. Actual physical activity improved by 0.7%. Patients' body function, capacity, and self-reported physical functioning also improved. The effects of the surgery on these aspects of physical functioning were similar for THA and TKA. The effect on actual physical activity (8%) was smaller than on body function (80%-167%), capacity (19%-36%), and self-reported physical functioning (87%-112%). Therefore, in contrast to the large effect on pain and stiffness, patients' capacity, and their self-reported physical functioning, the improvement in actual physical activity of our patients was less than expected 6 months after surgery. ⋯ Level I, prospective study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Sep 2008
Case ReportsCase report: meralgia paresthetica in a baseball pitcher.
We report a case of meralgia paresthetica occurring in an amateur baseball pitcher who experienced inguinal pain and dysesthesia in the anterolateral thigh during pitching practice. The lateral femoral cutaneous nerve was pushed up by the iliac muscle to the inguinal ligament at the sharp ridge of its fascia and ensheathed in the tendinous origin of the sartorius muscle. Neurolysis of the lateral femoral cutaneous nerve and partial dissection of the inguinal ligament and sartorius muscle promptly relieved the symptoms and the patient resumed pitching 1 month later. These anatomic variations of the lateral femoral cutaneous nerve in the inguinal region might render the nerve susceptible to compression and irritation, and repetitive contraction of inguinal muscles during throwing motion might induce and exacerbate the neuropathy of the lateral femoral cutaneous nerve.
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Clin. Orthop. Relat. Res. · Sep 2008
Case ReportsCase reports: splenic rupture after anterior thoracolumbar spinal fusion through a thoracoabdominal approach.
The anterior approach in spinal deformity surgery has increased in popularity in recent years. The thoracoabdominal approach to the thoracolumbar spine is associated with numerous possible complications, including injury to vital intraabdominal structures in close proximity to the area of exposure, such as the spleen. ⋯ Because the suspected etiology of the splenic hemorrhage was related to retraction, surgeons using the anterior approach should consider intermittent release of retractors and inspection of intraabdominal structures. Splenic rupture should be considered as part of the differential diagnosis for patients with hemodynamic instability after anterior approaches to the thoracolumbar spine.
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Clin. Orthop. Relat. Res. · Sep 2008
Sacral chordoma: can local recurrence after sacrectomy be predicted?
Surgical resection margins are reportedly the most important predictor of survival and local recurrence with sacral chordomas. We examined the relevance of invasion of the surrounding posterior pelvic musculature (piriformis and gluteus maximus) at initial diagnosis to local recurrence after sacrectomy. We retrospectively reviewed 18 patients with histologically verified sacral chordoma seen at our institution between 1998 and 2005. There were 14 men and four women with a mean age of 65.1 years (range, 31-78 years). The average overall followup was 4.4 years (range, 0.5-10 years), 5.4 years for the living patients (range, 3-10 years), and 2.8 years for the deceased (range, 0.5-5.4 years). Local recurrence occurred in 12 patients (66%) 29 months postoperatively (range, 2-84 months). Six of these patients had wide excisions at initial surgery, five had marginal excisions, and one had an intralesional excision. Ten patients had wide surgical margins, six of whom (60%) had local recurrences. Tumor invasion of adjacent muscles at presentation was present in 14 patients, 12 of whom (85%) had local recurrences. Sacroiliac joint involvement was seen in 10 patients, nine of whom (90%) had local recurrences. The findings suggest obtaining wide surgical margins posteriorly, by excising parts of the piriformis, gluteus maximus, and sacroiliac joints, may result in better local disease control in patients with sacral chordoma. ⋯ Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.