Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2013
The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years?
The Articular Surface Replacement™ (ASR™) metal-on-metal hip arthroplasty system (DePuy Orthopaedics, Inc, Warsaw, IN, USA) reportedly has a higher than anticipated early failure rate leading to a voluntary recall. This prompted us to evaluate all ASR™ components implanted at our center. ⋯ Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Feb 2013
Validation of the Korean version of the Oxford Knee Score in patients undergoing total knee arthroplasty.
Although translated versions of the Oxford Knee Score (OKS) in several languages are available, the absence of a Korean version precludes comparing data from Korea with that from other countries using the OKS. ⋯ The adapted Korean version of the OKS was translated and showed acceptable measurement properties. The data suggest it is suitable for assessing outcomes in Korean-speaking patients having TKAs.
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Clin. Orthop. Relat. Res. · Feb 2013
When do readmissions for infection occur after spine and total joint procedures?
The episode-of-care concept promulgated by the federal government requires hospitals to assume the cost burden for all care rendered up to 30 days after discharge, including all readmissions occurring in that time. Although surgical site infections (SSIs) are a leading cause of readmission after total joint arthroplasties (TJA) and spine surgery, it is unclear whether these readmissions occur relative to the 30-day period. ⋯ With the episode-of-care model, SSIs pose a substantial cost burden for hospitals since the majority would be included in the 30-day period included in the bundled reimbursement.
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Clin. Orthop. Relat. Res. · Jan 2013
Randomized Controlled TrialThe 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study.
Postoperative pain after total knee arthroplasty remains one of the most important challenges facing patients undergoing this surgery. Providing a balance of adequate analgesia while limiting the functional impact of regional anesthesia and minimizing opioid side effects is critical to minimize adverse events and improve patient satisfaction. ⋯ In patients undergoing TKA, continuous intraarticular analgesia provided an effective adjunct for pain relief in the immediate postoperative period without the disadvantages encountered with other analgesic methods.
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Clin. Orthop. Relat. Res. · Jan 2013
Randomized Controlled Trial Comparative StudyHigher cefazolin concentrations with intraosseous regional prophylaxis in TKA.
Prophylactic antibiotics reduce the risk of deep infection after primary TKA. However, conventional systemic dosing may not provide adequate tissue concentrations against more resistant organisms such as coagulase-negative staphylococci. Regional intravenous administration of antibiotics after tourniquet inflation achieves far higher tissue concentrations but requires foot vein cannulation. The intraosseous route may offer a rapid and reliable method of regional administration. ⋯ Intraosseous regional administration can achieve concentrations of antibiotic in tissue an order of magnitude higher than systemic administration. Further work is required to determine if this translates into increased efficacy in preventing infection, particularly against coagulase-negative staphylococci.