Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2014
Causes and frequency of unplanned hospital readmission after total hip arthroplasty.
Total hip arthroplasty (THA) is a beneficial and cost-effective procedure for patients with osteoarthritis. Recent initiatives to improve hospital quality of care include assessing unplanned hospital readmission rates. Patients presenting for THA have different indications and medical comorbidities that may impact rates of readmission. ⋯ Higher rates of unplanned hospital readmissions in revision THA rather than primary THA suggest that healthcare quality measures that incorporate readmission rates as a proxy for quality of care should distinguish between primary and revision procedures. Failure to do so may negatively impact tertiary referral hospitals that often care for patients requiring complex revision procedures.
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Clin. Orthop. Relat. Res. · Feb 2014
Are short fully coated stems adequate for "simple" femoral revisions?
Many studies suggest long femoral components should be used in revision THA. However, longer stems are more difficult to insert and reduce femoral bone stock for future revisions. ⋯ Primary-length extensively coated stems provided reliable fixation for ½ of our Paprosky Type I to IIIA femoral revisions. When considering the use of such a component, the revision surgeon should take into account a small risk of failed osseointegration and technical challenges associated with this technique.
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Clin. Orthop. Relat. Res. · Feb 2014
Surgical technique: Gluteus maximus and tensor fascia lata transfer for primary deficiency of the abductors of the hip.
Avulsion of the abductor muscles of the hip may cause severe limp and pain. Limited literature is available on treatment approaches for this problem, and each has shortcomings. This study describes a muscle transfer technique to treat complete irreparable avulsion of the hip abductor muscles and tendons. ⋯ The anterior portion of the gluteus maximus and the TFL can be transferred to the greater trochanter to substitute for abductor deficiency. In this small series, the surgical procedure was reproducible and effective; further studies with more patients and longer followup are needed to confirm this.
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Clin. Orthop. Relat. Res. · Feb 2014
Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures.
Surgeons have several implant choices when managing Vancouver B2 and B3 periprosthetic fractures about the hip. Few long-term studies have reported outcomes for tapered fluted titanium stems. ⋯ We report encouraging short-term results in terms of survival of distal taper stems in the treatment of B2 and B3 periprosthetic fractures. Although subsidence was frequent, most migrated less than 3 mm without correlation to poor pain and functional scores.
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Clin. Orthop. Relat. Res. · Feb 2014
Coexisting lumbar spondylosis in patients undergoing TKA: how common and how serious?
Information on the coexistence of lumbar spondylosis and its influence on overall levels of pain and function in patients with advanced knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA) would be valuable for patient consultation and management. ⋯ Radiographic lumbar spine degeneration and lumbar spine symptoms are common among patients with advanced knee OA undergoing TKA. Severe lumbar spine symptoms (visual analog scale score of ≥ 7) were likely to adversely affect the preoperative clinical scores of patients undergoing TKA; however, most of the adverse effects were not found 2 years after TKA. Nevertheless, because preexisting severe radiating pain during activity may be a source of a poorer outcome after TKA, careful patient consultation regarding this potential poorer prognosis after TKA needs to be provided to the patient with this symptom.