Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · May 2011
Can VEPTR(®) control progression of early-onset kyphoscoliosis? A cohort study of VEPTR(®) patients with severe kyphoscoliosis.
Kyphoscoliosis is considered a relative contraindication to treatment with the Vertical Expandable Prosthetic Titanium Rib (VEPTR(®); Synthes Inc, Paoli, PA). Nevertheless, patients do present with early-onset kyphoscoliosis and thoracic insufficiency syndrome, and no suitable alternative treatments are currently available. However, it is unclear whether VEPTR(®) is reasonable for treating patients with kyphoscoliosis. ⋯ Progression of kyphosis can be minimized during VEPTR(®) treatment by early extension of the construct to the second ribs bilaterally, distal extension of hybrid constructs to the pelvis, use of bilateral hybrid VEPTR(®) implants, and use of redesigned VEPTR(®) constructs that enhance fixation at the upper end. While our early results suggest these devices control progression of kyphosis, longer followup with more patients will be required to confirm the concept in these patients.
-
Clin. Orthop. Relat. Res. · May 2011
VEPTR™ growing rods for early-onset neuromuscular scoliosis: feasible and effective.
The Vertical Expandable Prosthetic Titanium Rib (VEPTR™; Synthes North America, West Chester, PA) reportedly controls spinal deformity associated with constrictive chest wall conditions. ⋯ VEPTR™ instrumentation as a spine-to-spine growing-rod construct demonstrated ease of implantation and expansion, with complication rates similar to other reported devices. This study suggests growing constructs using VEPTR™ can be used with relatively few complications and extends the potential uses of this instrumentation system.
-
Clin. Orthop. Relat. Res. · Apr 2011
The need for total hip arthroplasty in Perthes disease: a long-term study.
Legg-Calvé-Perthes disease (LCPD) was described a century ago. In previous long-term reports of patients with LCPD, nonoperative treatment varied considerably. The likelihood of hip osteoarthritis (OA) developing in patients with LCPD and possible need for THA are not well defined. ⋯ Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · Apr 2011
Comparative StudyMortality after distal femur fractures in elderly patients.
Hip fractures in the elderly are associated with high 1-year mortality rates, but whether patients with other lower extremity fractures are exposed to a similar mortality risk is not clear. ⋯ Level II, prognostic study. See the guidelines online for a complete description of evidence.
-
Clin. Orthop. Relat. Res. · Apr 2011
Comparative StudyTotal shoulder arthroplasty in older patients: increased perioperative morbidity?
More elderly patients are becoming candidates for total shoulder arthroplasty with an increase in frequency of the procedure paralleling the rise in other total joint arthroplasties. Controversy still exists, however, regarding the perioperative morbidity of total joint arthroplasty in elderly patients, particularly those 80 years of age and older. ⋯ Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.