Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2009
Does TKA improve functional outcome and range of motion in patients with stiff knees?
The main goals of TKA are pain relief and improvement of function and range of motion (ROM). To ascertain whether TKA in patients with stiff knees would relieve pain and improve functional outcome and ROM, we asked four questions: whether (1) Knee Society and WOMAC scores would improve after TKA; (2) poor preoperative ROM would improve after TKA; (3) the revision rate of TKA in stiff knees would be high; and (4) complication rates would be high in these patients after TKA. We retrospectively reviewed 74 patients (86 knees) with stiff knees (mean age, 56.8 years) who underwent TKAs with a condylar constrained or a posterior stabilized prosthesis. The minimum followup was 5 years (mean, 9.1 years; range, 5-12 years). The mean preoperative Hospital for Special Surgery knee score and Knee Society knee and functional scores were 42, 11, and 42 points, respectively, and postoperatively they were 84, 90, and 84 points, respectively. Preoperative and postoperative total WOMAC scores were 73 and 34 points, respectively. One knee (1.2%) had aseptic loosening of the tibial component and 12 knees (14%) had complications. Despite a relatively high rate of complications, most patients had substantial improvement in function. ⋯ Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2009
Review Case ReportsCase report: reconstruction of a recalcitrant scapular neck nonunion and literature review.
We present the first reported treatment failure of a reconstructed scapula body that proceeded to nonunion. This is a unique case report of an otherwise healthy patient who underwent open reduction and internal fixation of a scapula fracture nonunion, which is very rare. ⋯ Of 159 reported cases of open reduction and internal fixation for treatment of scapula neck and body fractures (with or without intraarticular glenoid fractures), there is not one reported case of a nonunion. Our case is described in detail, including the method of surgical reconstruction, and a review of the literature regarding surgical treatment of scapula nonunions after nonoperative treatment also is presented.
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Clin. Orthop. Relat. Res. · Apr 2009
Modified Pauwels' intertrochanteric osteotomy in neglected femoral neck fracture.
Many reported treatment methods for neglected femoral neck fractures do not always satisfactorily address nonunion, coxa vara, and limb shortening. We retrospectively reviewed the functional outcome of the modified Pauwels' intertrochanteric osteotomy in 48 adults (mean age, 48.1 years) to determine whether this approach would correct those problems. The average preoperative limb shortening was 2.7 cm (range, 1.5-5 cm) in 38 patients and mean neck-shaft angle was 107.3 degrees (range, 80 degrees -120 degrees ). The minimum followup was 2 years (mean, 6.1 years; range, 2-16.5 years). Union was achieved in 44 of the 48 patients. Union also was achieved in two of the four nonunions after revision osteotomy. Postoperative avascular necrosis of the femoral head developed in two of the 48 patients after an average followup of 6 years. Limb-length equalization was achieved in 40 (83%) patients and 40 had near-normal gait. The average neck-shaft angle at the final followup was 132.7 degrees (range, 120 degrees -155 degrees ). The average Harris hip score was 86.7 points and Merle d'Aubigné-Postel score was 14.1. We believe the primary modified Pauwels' intertrochanteric osteotomy is a reliable alternative to achieve fracture healing in neglected femoral neck fractures and simultaneously correct associated coxa vara and shortening. A two-stage surgical incision makes the procedure simple and less demanding. ⋯ Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Apr 2009
Estimation of patient dose and associated radiogenic risks from limb lengthening.
Limb-lengthening procedures include a series of radiographic examinations to follow the lengthening process and callus formation. We quantified ionizing radiation exposure during lengthening treatment and estimated the risks associated with this exposure in 53 patients undergoing lengthening procedures. Field size and tube voltage of all radiographs and fluoroscopy time during surgery were recorded. According to conversion factor tables of organ doses, the cumulative organ dose was estimated. Location of lengthening, age, complications during lengthening procedure, range of lengthening, healing index, and other factors affecting the duration of the lengthening procedures were analyzed. Average lengthening was 4.8 cm (range, 3.0-12.5 cm). The average cumulative organ dose for a straight lengthening procedure was 3.1 mSv (range, 0.2-12.5 mSv). The average organ dose per centimeter of lengthening was 0.7 mSv/cm (range, 0.03-5.9 mSv/cm). Doses for patients with tibial lengthening (0.3 mSv/cm) were less than doses for patients with femoral lengthening (1.1 mSv/cm). Age, complications, range of lengthening, and healing index did not influence the dosage of radiation per centimeter lengthening. We judge the average patient's exposure during a limb-lengthening procedure as tolerable, but femur lengthening results in a higher cumulative organ dose. ⋯ Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.