Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jan 2012
Comparative StudyImproved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA.
Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA. ⋯ Patient-specific positioning guides can assist in achieving a neutral mechanical axis with reduction in outliers.
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Clin. Orthop. Relat. Res. · Jan 2012
Can a high-flexion total knee arthroplasty relieve pain and restore function without premature failure?
High-flexion TKA prostheses are designed to improve flexion and clinical outcomes. Increased knee flexion can increase implant loads and fixation stresses, creating concerns of premature failure. Whether these goals can be achieved without premature failures is unclear. ⋯ Our data were similar to those reported in patients implanted with traditional and other designs of high-flexion TKA. We found no increased incidence of premature failure, although a higher than expected incidence of posterior femoral radiolucent lines merit continued observation. Patients with less preoperative motion were more likely to benefit from a high-flexion TKA.
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Clin. Orthop. Relat. Res. · Jan 2012
Comparative StudyIncidence of patients with lower extremity injuries presenting to US emergency departments by anatomic region, disease category, and age.
The incidence of patients with lower extremity injuries presenting to emergency departments in the United States with respect to specific anatomic regions and disease categories is unknown. Such information might be used for injury prevention, resource allocation, and training priorities. ⋯ Given relatively low-acuity leg problems such as strains and sprains account for a substantial number of emergency department visits pertaining to leg problems, use of telephone triage, scheduled same or next-day urgent care appointments, and other alternatives to the traditional emergency room might result in better use of emergency healthcare resources.
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Clin. Orthop. Relat. Res. · Jan 2012
Comparative StudyMinimizing dynamic knee spacer complications in infected revision arthroplasty.
Deep infections are devastating complications of TKA often treated with component explantation, intravenous antibiotics, and antibiotic-impregnated cement spacers. Historically, the spacers have been static, which may limit patients' ROM and ability to walk. Several recent reports describe dynamic spacers, which may allow for improved ROM and make later reimplantation easier. However, because of several dynamic spacer problems noted at our institution, we wanted to assess their associated failures, reinfection rates, and functionality. ⋯ Reinfection rates, Knee Society scores, and ROM were comparable between the static and dynamic spacer groups. Meticulous surgical technique and proper patient selection should be used to avoid any complications with any spacers.