Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2010
Comparative StudyComparing patient outcomes after THA and TKA: is there a difference?
Both primary total hip (THA) and knee (TKA) arthroplasty relieve pain, restore function, and increase mobility. Despite these successes, there is controversy as to whether THA or TKA provides greater or similar improvement. We therefore compared primary THA and TKA patient results in terms of (1) willingness to have surgery again; (2) WOMAC change score; (3) whether expectations were met; and (4) satisfaction. Patients undergoing primary THA were more willing to undergo their surgery again (THA 96%, TKA 89%), demonstrated greater WOMAC change scores, more frequently reported their expectations were met (THA 78%, TKA 70%), and expressed greater overall satisfaction (THA 89%, TKA 81%). In addition, patients undergoing THA expressed higher satisfaction with pain reduction while performing activities (ie, walking, stairs, and sitting/lying) and their ability to perform daily activities (ie, stairs, transportation, getting up, lying in bed, and light domestic duties) when compared with patients undergoing TKA. Our data suggest primary THA offers superior short-term outcomes when compared with primary TKA. ⋯ Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Feb 2010
Case ReportsCase report: Bowel perforation presenting as subcutaneous emphysema of the thigh.
Necrotizing fasciitis is recognized as a surgical emergency. Early detection and aggressive surgical débridement are crucial to reduce patient mortality and morbidity. There are, however, other causes of subcutaneous emphysema. ⋯ Surgical exploration revealed the source of the emphysema to be an enterocutaneous fistula. The patient had an unstable and prolonged hospitalization after débridements of the thigh and abdominal surgery and was readmitted for recurrence of thigh drainage, but eventually was discharged; nine months after the initial diagnosis all wounds had healed and he was walking with a walker. Despite an otherwise benign clinical appearance, the radiographic finding of subcutaneous emphysema in the absence of penetrating trauma must be considered a case of a necrotizing soft tissue infection until proven otherwise.
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Clin. Orthop. Relat. Res. · Feb 2010
Iliopsoas bursa injections can be beneficial for pain after total hip arthroplasty.
Impingement of the iliopsoas tendon is an uncommon cause of groin pain after total hip arthroplasty (THA). We asked whether selective steroid and anesthetic injections for iliopsoas tendonitis after THA would relieve pain and improve function. We retrospectively reviewed 27 patients with presumed iliopsoas tendinitis treated by fluoroscopically guided injections of the iliopsoas bursa. Pre- and immediately postinjection, questionnaires and telephone followup questionnaires were administered to determine patient outcomes. Four patients were lost to followup and we were unable to obtain information from relatives on an additional four; the questionnaire was administered to the remaining 19 patients, including six who subsequently had surgery at an average of 44.6 months (range, 25-68 months) after their first injection. The average modified Harris hip score in the 19 patients improved from 61 preinjection to 82 postinjection and the average pain improved from 6.4 preinjection to 2.9 postinjection, but eight patients (30%) required a second injection at an average of 8.2 months after the first injection. Ultimately, six patients (22%) had an additional surgical procedure to address the underlying cause of the iliopsoas irritation. Iliopsoas tendonitis is uncommon after THA but should be considered in the differential diagnosis of all patients who present with groin pain after THA. Selective steroid and anesthetic injections of the iliopsoas bursa give adequate pain relief in the majority of patients and should be considered part of the nonoperative treatment plan before surgical release of the iliopsoas tendon or component revision. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.