Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 2010
Review Case ReportsCase report: Spinal anesthesia by mini-laminotomy for a patient with ankylosing spondylitis who was difficult to anesthetize.
Orthopaedic surgeons frequently encounter patients with ankylosing spondylitis who would benefit from various types of lower limb operations; however, some of these patients present challenges for anesthesiologists. ⋯ We achieved successful anesthesia using spinal laminotomy with the patient under local anesthesia followed by insertion of a spinal catheter and injection of an anesthetic agent. The loosened component was revised to a cementless THA.
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Clin. Orthop. Relat. Res. · Dec 2010
Review Case ReportsCase reports: Painful limbs/moving extremities: report of two cases.
Painful limbs/moving extremities is a relatively rare condition characterized by aching pain in one limb and involuntary movement in the affected fingers or toes. Its pathomechanism is unknown. We report two patients with painful limbs/moving extremities. In one patient with a painful arm and moving fingers, the symptoms were resolved after surgery. ⋯ If imaging indicates compression of nerve tissue, we believe surgical decompression should be considered for patients with painful limbs/moving extremities who do not respond to nonoperative treatment.
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Clin. Orthop. Relat. Res. · Dec 2010
Delayed foreign-body reaction to absorbable implants in metacarpal fracture treatment.
First-generation bioabsorbable implants have been associated with a high complication rate attributable to weak mechanical properties and rapid degradation. This has led to the development of stronger devices with improved durability. However, the modern implants have raised concerns about potential late-occurring adverse reactions. ⋯ Our results indicate these absorbable implants for metacarpal fractures achieved adequate bone healing but simply postponed the problem of foreign-body reactions. Patients treated with bioabsorbable implants should be advised of potential late complications and should be followed for at least 2 years, possibly longer.
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Clin. Orthop. Relat. Res. · Dec 2010
Randomized Controlled Trial Comparative StudyA prospective randomized trial of mini-incision posterior and two-incision total hip arthroplasty.
The two-incision approach to THA has been controversial, with some authors reporting its use is associated with a rapid recovery whereas others report no differences in outcomes and a higher risk of perioperative complications secondary to increased surgical complexity. ⋯ We found no differences in perioperative outcomes between these two approaches for THA. Variables other than the surgical approach including perioperative protocols, patient expectations, and the patient's general health may have a greater effect on outcomes such as pain during the early postoperative period, functional recovery, and length of hospital stay. The use of small incisions for THA was safe as was a shortened hospital stay in selected patients.
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Clin. Orthop. Relat. Res. · Dec 2010
Comparative StudyEthnic and gender differences in the functional disparities after primary total knee arthroplasty.
The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA. ⋯ Gender and race affected functional KSS and ROM variables. The worse results experienced by African-American women may be attributable to a longer delay to presentation. However, the scores and motion were high for all subgroups, and underuse of TKA in women and African-Americans cannot be justified based on a perception of lesser functional gains.