Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2018
Comparative Study Observational StudyOutcomes After Metal-on-metal Hip Revision Surgery Depend on the Reason for Failure: A Propensity Score-matched Study.
Metal-on-metal hip replacement (MoMHR) revision surgery for adverse reactions to metal debris (ARMD) has been associated with an increased risk of early complications and reoperation and inferior patient-reported outcome scores compared with non-ARMD revisions. As a result, early revision specifically for ARMD with adoption of a lower surgical threshold has been widely recommended with the goal of improving the subsequent prognosis after ARMD revisions. However, no large cohorts have compared the risk of complications and reoperation after MoMHR revision surgery for ARMD (an unanticipated revision indication) with those after non-ARMD revisions (which represent conventional modes of arthroplasty revision). ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Feb 2018
Comparative StudyThe Safe Zone Range for Cup Anteversion Is Narrower Than for Inclination in THA.
Cup malposition is a common cause of impingement, limitation of ROM, acceleration of bearing wear, liner fracture, and instability in THA. Previous studies of the safe zone based on plain radiographs have limitations inherent to measuring angles from two-dimensional projections. The current study uses CT to measure component position in stable and unstable hips to assess the presence of a safe zone for cup position in THA. ⋯ Level III, diagnostic study.
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Clin. Orthop. Relat. Res. · Feb 2018
Comparative StudyMobile Compression Reduces Bleeding-related Readmissions and Wound Complications After THA and TKA.
The use of chemoprophylaxis to prevent thromboembolic disease after primary THA and TKA can be associated with postoperative bleeding complications. Mechanical prophylaxis has been studied as an alternative to chemoprophylaxis with greater safety in patients undergoing THA, but no data have been published comparing the safety of chemoprophylaxis versus mechanical methods for patients undergoing TKA. The risk of readmission resulting from bleeding and venous thromboembolism (VTE) has also not been determined for patients undergoing THA or TKA when treated with low-molecular-weight heparin (LMWH) alone compared with mechanical prophylaxis plus aspirin (ASA). ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Feb 2018
Femoral Component Varus Malposition is Associated with Tibial Aseptic Loosening After TKA.
The notion that neutral alignment is mandatory to assure long-term durability after TKA has been based mostly on short-film studies. However, this is challenged by recent long-film studies. ⋯ Level III, therapeutic study.
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Patients with lumbar spine and hip disorders may, during the course of their treatment, undergo spinal fusion and THA. There is disagreement among prior studies regarding whether patients who undergo THA and spinal fusion are at increased risk of THA dislocation and other hip-related complications. ⋯ Level III, therapeutic study.