Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2019
What Is the Prevalence of Cam Deformity After Prophylactic Pinning of the Contralateral Asymptomatic Hip in Unilateral Slipped Capital Femoral Epiphysis? A 10-year Minimum Followup Study.
Prophylactic pinning of the asymptomatic and normal-appearing contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) remains controversial. Understanding the minimal 10-year clinical, functional, and radiographic outcomes of the contralateral asymptomatic hip in unilateral SCFE may be helpful in the decision regarding whether the benefits associated with potentially preventing a SCFE are outweighed by the risk of additional surgery. ⋯ Level IV, therapeutic study.
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Clin. Orthop. Relat. Res. · May 2019
Do dGEMRIC and T2 Imaging Correlate With Histologic Cartilage Degeneration in an Experimental Ovine FAI Model?
Biochemical MRI of hip cartilage such as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping is increasingly used to judge cartilage quality in the assessment of femoroacetabular impingement (FAI). The current evidence is sparse about which of these techniques yields a stronger correlation with histologic cartilage degeneration because of the difficulty in validating biochemical MRI techniques against histology in the clinical setting. Recently, an experimental ovine FAI model was established that induces chondrolabral damage and offers a validated platform to address these limitations. ⋯ This translational study supports the continuing use of dGEMRIC as a biomarker for prearthritic cartilage degeneration with the ultimate goal to identify patients who will benefit most from corrective FAI surgery. The value of T2 imaging of hip cartilage warrants further investigation.
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Clin. Orthop. Relat. Res. · May 2019
Meta AnalysisIs the Risk of Infection Lower with Sutures than with Staples for Skin Closure After Orthopaedic Surgery? A Meta-analysis of Randomized Trials.
Two previous meta-analyses comparing staples versus sutures have led to conflicting relative risks for surgical site infection between skin closure methods after orthopaedic surgery. Consequently, the choice of sutures or staples for skin closure continues to be a subject of conversation. Recently, additional randomized trials have been published, and an updated meta-analysis is needed to inform this debate. ⋯ Level I, therapeutic study.
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Clin. Orthop. Relat. Res. · May 2019
What Is the Association Between Articular Cartilage Damage and Subsequent THA 20 Years After Hip Arthroscopy for Labral Tears?
Few studies have examined long-term outcomes for patients after arthroscopic treatment for intraarticular hip conditions, and none have done so beyond 10 years postarthroscopy. Examining outcomes beyond 10 years is necessary to determine factors that contribute to conversion to THA in patients undergoing hip arthroscopy for labrochondral damage. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · May 2019
Cannulated Screw Prominence in Tension Band Wiring of Patella Fractures Increases Fracture Gapping: A Cadaver Study.
Transverse patella fractures are often treated with cannulated screws and a figure-of-eight anterior tension band. A common teaching regarding this construct is to recess the screws so that their distal ends do not protrude beyond the patella because doing so may improve biomechanical performance. However, there is a lack of biomechanical or clinical data to support this recommendation. ⋯ This biomechanical cadaver study found that the use of prominent cannulated screws for the fixation of transverse patella fractures increases the likelihood of interfragmentary gap formation, which may potentially increase the risk of fracture nonunion and implant failure. These findings suggest that proximally and distally recessed screws may increase construct stability, which may increase the potential for bony healing. The findings support further laboratory and clinical investigations comparing recessed screws supplemented by anterior tension banding with other repair methods that are in common use, such as transosseous suture repair.