Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 2014
Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears.
In many areas of orthopaedics, patients with greater levels of psychological distress report inferior self-assessments of pain and function. This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychological component. ⋯ Level I, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Dec 2014
ReviewHow have alternative bearings and modularity affected revision rates in total hip arthroplasty?
Total hip arthroplasty (THA) continues to be one of the most successful surgical procedures in the medical field. However, over the last two decades, the use of modularity and alternative bearings in THA has become routine. Given the known problems associated with hard-on-hard bearing couples, including taper failures with more modular stem designs, local and systemic effects from metal-on-metal bearings, and fractures with ceramic-on-ceramic bearings, it is not known whether in aggregate the survivorship of these implants is better or worse than the metal-on-polyethylene bearings that they sought to replace. ⋯ Despite improvements in implant technology, there is no evidence that alternative bearings or modularity have resulted in decreased THA revision rates after 5 years. In fact, both large head metal-on-metal THA and added modularity may well lower survivorship and should only be used in select cases in which the mission cannot be achieved without it. Based on this experience, followup and/or postmarket surveillance studies should have a duration of at least 5 years before introducing new alternative bearings or modularity on a widespread scale.
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Clin. Orthop. Relat. Res. · Dec 2014
Comparative StudyIs synovial C-reactive protein a useful marker for periprosthetic joint infection?
Serum C-reactive protein (CRP) is a general marker of inflammation, and recent studies suggest that measurement of CRP in synovial fluid may be a more accurate method for diagnosing periprosthetic joint infection (PJI). ⋯ Level II, diagnostic study. See the Instructions to Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Dec 2014
ReviewWhich design and biomaterial factors affect clinical wear performance of total disc replacements? A systematic review.
Total disc replacement was clinically introduced to reduce pain and preserve segmental motion of the lumbar and cervical spine. Previous case studies have reported on the wear and adverse local tissue reactions around artificial prostheses, but it is unclear how design and biomaterials affect clinical outcomes. ⋯ This review provides evidence that design and biomaterials affect the type of wear and inflammation. However, clinical study design, followup, and analytical techniques differ among investigations, preventing us from drawing firm conclusions about the relationship between implant design and wear performance for both cervical and lumbar total disc replacement.
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Clin. Orthop. Relat. Res. · Dec 2014
Patient activity after TKA depends on patient-specific parameters.
Most patients expect an improvement of walking ability and an increase in activity levels after TKA. Unfortunately, few studies report qualitative and quantitative activity improvements after TKA. ⋯ Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.