Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 2020
A Low Percentage of Patients Satisfy Typical Indications for Single-stage Exchange Arthroplasty for Chronic Periprosthetic Joint Infection.
Periprosthetic joint infection (PJI) is a leading cause of revision arthroplasty. Considerable controversy still exists whether single- or two-stage exchange is the better approach for patients with chronic PJI. Historically, single-stage exchange arthroplasty was thought to have an unacceptably high risk of reinfection compared with two-stage exchange but recent studies have demonstrated that this may not be the case. To be considered for single-stage exchange, patients should meet certain criteria including a preoperatively identified nonvirulent pathogen in an immunocompetent host with an uncompromised soft tissue envelope. It is unclear what proportion of patients with chronic PJI actually meet these criteria. Additionally, patients who meet the criteria for single-stage exchange are selected because, in principle, they may be more likely to be able to overcome the infection, but it is unknown what the reinfection risk is in patients undergoing two-stage exchange who might have met selection criteria for single-stage exchange. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Aug 2020
Obesity Increases the Risk of Tendinopathy, Tendon Tear and Rupture, and Postoperative Complications: A Systematic Review of Clinical Studies.
Inflammation and mechanical demands play a role in the development of tendon conditions and the dysregulation of tendon healing. In patients with obesity, high levels of pro-inflammatory cytokines and a high mechanical demand promote chronic low-grade inflammation. Although controversial results have been reported, we aimed to summarize current evidence while highlighting the role of obesity in tendinopathy. ⋯ Level IV, prognostic study.
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Clin. Orthop. Relat. Res. · Aug 2020
Randomized Controlled TrialPlatelet-rich Plasma or Autologous Blood Do Not Reduce Pain or Improve Function in Patients with Lateral Epicondylitis: A Randomized Controlled Trial.
Platelet-rich plasma (PRP) and autologous blood are commonly used therapies for lateral epicondylitis, but the evidence from randomized, placebo-controlled trials is conflicting. Thus, it is still unclear if patients benefit from these treatments. ⋯ Level II, therapeutic study.
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Clin. Orthop. Relat. Res. · Aug 2020
Delays to Surgery and Coronal Malalignment Are Associated with Reoperation after Open Tibia Fractures in Tanzania.
Treatment of diaphyseal open tibia fractures often results in reoperation and impaired quality of life. Few studies, particularly in resource-limited settings, have described factors associated with outcomes after these fractures. ⋯ Level II, therapeutic study.
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Clin. Orthop. Relat. Res. · Aug 2020
Randomized Controlled TrialDoes Preoperative Decolonization Reduce Surgical Site Infections in Elective Orthopaedic Surgery? A Prospective Randomized Controlled Trial.
Surgical site infections (SSIs) after elective orthopaedic surgery are very stressful for patients due to frequent rehospitalizations with reoperations and poorer functional outcomes. Prevention of such events is therefore crucial. Although an evidence-based consensus is still lacking, preoperative decolonization could decrease SSI. Specifically, more information is needed about the effect of a preoperative decolonization procedure on SSI proportions in both Staphylococcus aureus carriers and non-S. aureus carriers after general orthopaedic surgery. ⋯ Level II, therapeutic study.