Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jan 2014
What are the rates and causes of hospital readmission after total knee arthroplasty?
Total knee arthroplasty (TKA) and related interventions such as revision TKA and the treatment of infected TKAs are commonly performed procedures. Hospital readmission rates are used to measure hospital performance, but risk factors (both medical and surgical) for readmission after TKA, revision TKA, and treatment for the infected TKA have not been well characterized. ⋯ Patients having revision TKA, whether for infection or other causes, are more likely to have an unplanned readmission to the hospital than are patients having primary TKA. When assessing hospital performance for TKA, it is important to distinguish among these surgical procedures.
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Clin. Orthop. Relat. Res. · Jan 2014
Multicenter StudyCauses, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study.
Failure after total knee arthroplasty (TKA) may be related to emerging technologies, surgical techniques, and changing patient demographics. Over the past decade, TKA use in Korea has increased substantially, and demographic trends have diverged from those of Western countries, but failure mechanisms in Korea have not been well studied. ⋯ Despite a recent remarkable increase in TKA use and differences in demographic features, the causes and risk factors for failures in Korea were similar to those of Western countries. Infection was the most common cause of failure, but loosening has emerged as the most common cause in more recent years, which would prompt us to scrutinize the cause and solution to reduce it.
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Clin. Orthop. Relat. Res. · Jan 2014
Randomized Controlled TrialRandomized trial of hemiarthroplasty versus internal fixation for femoral neck fractures: no differences at 6 years.
Hemiarthroplasty has been shown superior to internal fixation for displaced femoral neck fractures (FNF) in the first 2 years. However, there are unanswered questions about the performance of hemiarthroplasty over the longer term compared with internal fixation. ⋯ Hemiarthroplasty has predictable and good long-term results after FNF and is the treatment of choice compared with internal fixation. Further studies will evaluate if total hip arthroplasty has advantages over hemiarthroplasty in patients with fracture with long life expectancy.
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Clin. Orthop. Relat. Res. · Jan 2014
Comparative StudyPlain radiographs underestimate the asymmetry of the posterior condylar offset of the knee compared with MRI.
Restoration of posterior condylar offset (PCO) during total knee arthroplasty is essential to maximize range of motion, prevent impingement, and minimize flexion instability. Previously, PCO was determined with lateral radiographs, which could not distinguish the asymmetries between the femoral condyles. MRI can independently measure both medial and lateral PCO. ⋯ Plain radiographs underestimate PCO as well as the asymmetry of the medial and lateral PCO compared with MRI. This discrepancy is the result of both articular cartilage thickness and the anatomic differences between medial and lateral condyles. Designers of knee prostheses and instrumentation should take these differences into account.
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Clin. Orthop. Relat. Res. · Jan 2014
Targeted use of vancomycin as perioperative prophylaxis reduces periprosthetic joint infection in revision TKA.
The role of vancomycin in surgical antimicrobial prophylaxis and high-risk patients who are most likely to benefit remains unclear. ⋯ Targeted use of vancomycin in patients undergoing revision TKA was effective in reducing the rate of PJI and PJI resulting from methicillin-resistant organisms in an institution with a high baseline rate of PJI due to MRSA and MRSE. Identification of high-risk subgroups of patients within a surgical population can help target infection prevention strategies to those who are most likely to benefit and thus minimize potential risks (eg, selection of resistant organisms, adverse drug events) associated with broader application of such an intervention.