Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jan 2014
Randomized Controlled TrialIntraarticular fibrinogen does not reduce blood loss in TKA: a randomized clinical trial.
Bleeding remains an ongoing concern after total knee arthroplasty (TKA). Intraarticular application of human fibrinogen with a topical thrombin has been described to stop diffuse bleeding in knee arthroplasty. ⋯ The use of fibrinogen in TKA did not lead to a significant reduction of blood loss or transfusions in primary TKA for osteoarthritis. Given the lack of benefits and the costs this procedure adds to TKA, its routine use cannot be justified during primary TKA for osteoarthritis.
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Clin. Orthop. Relat. Res. · Jan 2014
Total knee arthroplasty after high tibial osteotomy: no differences between medial and lateral osteotomy approaches.
High tibial osteotomy (HTO) has long been accepted as an effective treatment for unicompartmental osteoarthritis of the knee in young, active adults. For varus knees, the two most commonly performed valgus-producing HTOs are the lateral closing wedge and the medial opening wedge. Regardless of technique, some HTOs fail and are converted to TKA. To our knowledge, no studies have directly compared TKAs done after lateral closing-wedge osteotomies to those done after medial opening-wedge osteotomies. ⋯ Our results suggest there is no difference in functional outcomes or survivorship of TKA in patients having previously undergone medial opening-wedge and lateral closing-wedge HTOs.
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Clin. Orthop. Relat. Res. · Jan 2014
What are the rates and causes of hospital readmission after total knee arthroplasty?
Total knee arthroplasty (TKA) and related interventions such as revision TKA and the treatment of infected TKAs are commonly performed procedures. Hospital readmission rates are used to measure hospital performance, but risk factors (both medical and surgical) for readmission after TKA, revision TKA, and treatment for the infected TKA have not been well characterized. ⋯ Patients having revision TKA, whether for infection or other causes, are more likely to have an unplanned readmission to the hospital than are patients having primary TKA. When assessing hospital performance for TKA, it is important to distinguish among these surgical procedures.
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Clin. Orthop. Relat. Res. · Jan 2014
Multicenter StudyCauses, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study.
Failure after total knee arthroplasty (TKA) may be related to emerging technologies, surgical techniques, and changing patient demographics. Over the past decade, TKA use in Korea has increased substantially, and demographic trends have diverged from those of Western countries, but failure mechanisms in Korea have not been well studied. ⋯ Despite a recent remarkable increase in TKA use and differences in demographic features, the causes and risk factors for failures in Korea were similar to those of Western countries. Infection was the most common cause of failure, but loosening has emerged as the most common cause in more recent years, which would prompt us to scrutinize the cause and solution to reduce it.
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Clin. Orthop. Relat. Res. · Jan 2014
Randomized Controlled TrialRandomized trial of hemiarthroplasty versus internal fixation for femoral neck fractures: no differences at 6 years.
Hemiarthroplasty has been shown superior to internal fixation for displaced femoral neck fractures (FNF) in the first 2 years. However, there are unanswered questions about the performance of hemiarthroplasty over the longer term compared with internal fixation. ⋯ Hemiarthroplasty has predictable and good long-term results after FNF and is the treatment of choice compared with internal fixation. Further studies will evaluate if total hip arthroplasty has advantages over hemiarthroplasty in patients with fracture with long life expectancy.