Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 2010
Early experience with a novel nonmetallic cable in reconstructive hip surgery.
Metallic wires and cables are commonly used in primary and revision THA for fixation of periprosthetic fractures and osteotomies of the greater trochanter. These systems provide secure fixation and high healing rates but fraying, third-body generation, accelerated wear of the bearing surface, and injury to the surgical team remain concerning. ⋯ The nonmetallic periprosthetic cables used in this series provided adequate fixation to allow for both osteotomy and fracture healing. We did not observe any complications directly related to the cables. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Sep 2010
Comparative StudyHistological features of pseudotumor-like tissues from metal-on-metal hips.
Pseudotumor-like periprosthetic tissue reactions around metal-on-metal (M-M) hip replacements can cause pain and lead to revision surgery. The cause of these reactions is not well understood but could be due to excessive wear, or metal hypersensitivity or an as-yet unknown cause. The tissue features may help distinguish reactions to high wear from those with suspected metal hypersensitivity. ⋯ Painful hips with periprosthetic masses may be caused by high wear, but if this can be ruled out, metal hypersensitivity should be considered.
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Clin. Orthop. Relat. Res. · Sep 2010
Antiemesis after total joint arthroplasty: does a single preoperative dose of aprepitant reduce nausea and vomiting?
Postoperative nausea and vomiting (PONV) is frequent after joint arthroplasty; in addition to causing patient distress, it interferes with early mobilization and hospital discharge. Various antiemetic agents reduce PONV, but their action is limited by a short half-life. Aprepitant, an antiemetic developed for patients receiving chemotherapy, has a duration of action much longer than other antiemetics. ⋯ Level II, prognostic study. See guidelines for authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Aug 2010
Changes in the number of resident publications after inception of the 80-hour work week.
Since the inception of resident work-hour regulations, there has been considerable concern regarding the influence of decreased work hours on graduate medical education. In particular, it is unclear whether implementation of work-hour restrictions has influenced resident academic performance as defined by quantity of peer-reviewed publications while participating in graduate medical education. ⋯ Since implementation of work-hour changes, total resident publications and publications per resident-year have increased.
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Clin. Orthop. Relat. Res. · Aug 2010
A two-stage retention débridement protocol for acute periprosthetic joint infections.
Due to the historically poor infection control rates with débridement and component retention for acute periprosthetic infections we developed a new approach for treating acute periprosthetic total joint infections: initial débridement with prosthesis retention and placement of antibiotic-impregnated cement beads followed by a second débridement within 7 days, at which time the beads are removed and new modular parts inserted. Intravenous antibiotics were used for 6 weeks followed by oral antibiotics. Depending on the clinical situation, antibiotics are discontinued or in selected patients continued indefinitely. ⋯ Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.