Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2007
Outcomes of shoulder arthroplasty in Olmsted County, Minnesota: a population-based study.
Most studies on shoulder arthroplasty include a diverse group of patients presenting to a tertiary care center. Little information is available regarding outcomes in a community setting. We reviewed 98 residents (110 shoulders) of Olmsted County, Minnesota who had shoulder arthroplasties from 1976 to 2000. ⋯ There was a high rate of satisfactory or excellent results after total shoulder arthroplasty for osteoarthritis. Hemiarthroplasty offered less satisfactory results, most likely related to the use of this procedure for trauma. This information will assist the community surgeon in counseling patients and weighing the risks and benefits of a shoulder arthroplasty.
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Clin. Orthop. Relat. Res. · Feb 2007
Randomized Controlled Trial Comparative StudyIntramedullary fixation of tibial shaft fractures using an expandable nail.
Interlocking intramedullary nails are the gold standard for treating tibial fractures. We compared the clinical and economic factors associated with tibial fracture fixation using either interlocking intramedullary or expandable nails. From 2000 to 2002, 53 patients with 53 diaphyseal tibial fractures of similar characteristics (AO/OTA 42A1-B3) were randomly and prospectively treated with either interlocking (n = 26) or expandable nails (n = 27). ⋯ Expandable nails showed important clinical advantages for tibial fracture fixation, and complications related to lengthy operations, reoperations, and rehospitalizations were substantially reduced. Overall treatment cost was substantially lower with expandable nails. Based on these advantages, simplicity in use, and short surgical time, we recommend an expandable nail for treating tibial (AO Type A, B) shaft fractures.
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Clin. Orthop. Relat. Res. · Feb 2007
Comparative StudyShoulder arthroplasty versus hip and knee arthroplasties: a comparison of outcomes.
Although outcomes of shoulder, hip, and knee arthroplasties have been well-described, there have been no studies directly comparing the outcomes of these procedures as treatments for osteoarthritis. We compared the inpatient mortality, complications, length of stay, and total charges of patients who had shoulder arthroplasty for osteoarthritis with those of patients who had hip and knee arthroplasties for osteoarthritis. A review of the Maryland Health Services Cost Review Commission discharge database identified 994 shoulder arthroplasties, 15,414 hip arthroplasties, and 34,471 knee arthroplasties performed for osteoarthritis from 1994 to 2001. ⋯ Compared with patients who had hip or knee arthroplasties, patients who had shoulder arthroplasties had, on average, a lower complication rate, a shorter length of stay, and fewer total charges. The latter had 1/2 as many in-hospital complications, were 1/6 as likely to have a length of stay 6 days or greater, and were 1/10 as likely to be charged more than $15,000. We believe shoulder arthroplasty is as safe as the more commonly performed major joint arthroplasties.
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Clin. Orthop. Relat. Res. · Dec 2006
Comparative StudyMetal-on-metal hip resurfacing compares favorably with THA at 2 years followup.
Metal-on-metal total hip resurfacing is a bone-conserving reconstructive option for patients with advanced articular damage. While intended to address several problems with conventional THA, the safety and efficacy is not well established. We therefore retrospectively compared the outcomes of 52 patients (57 hips) with resurfacing arthroplasty to 84 patients (93 hips) with cementless primary THAs. ⋯ However, the resurfacing group had higher activity scores (14 versus 13, p < 0.001) and range of motion (ROM) scores (5.0 versus 4.8, p < 0.001). The complication rates (5.3% for resurfacing versus 14.0% for THA) and reoperation rates (3.5% for resurfacing versus 4.3% for THA) were similar. The total hip arthroplasty and metal-on-metal resurfacing groups both showed improvement in HHS, pain, activity, and ROM and had similar early complication and reoperation rates.
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The proinflammatory cytokines IL-1beta, IL-8, and TNF-alpha play a major role in the process of bone resorption during aseptic loosening of large joint prostheses. These cytokines secreted locally during bone resorption in aseptic loosening may enter peripheral circulation. Increased concentration of IL-1gamma, IL-8, and TNF-alpha in peripheral circulation may indicate aseptic loosening. ⋯ Cytokine levels were determined in plasma by ELISA tests. Patients with prosthesis loosening had higher plasma levels (IL-10, 3.7 +/- 5.5 pg/mL; IL-8, 14.7 +/- 9 pg/mL; TNF-alpha, 32.7 +/-+/- 32.4 pg/mL) than patients with stable prostheses (IL-1beta, 1.5 +/- 2 pg/mL; IL-8, 8.1 +/- 4.7 pg/mL; TNF-alpha, 22.9 +/- 18.7 pg/mL), patients with osteoarthritis (IL-1beta, 0.7 +/- 1.1 pg/mL; IL-8, 5.8 +/- 3.8 pg/mL; TNF-alpha, 9.8 +/- 7.7 pg/mL) and healthy individuals (IL-1beta, 0.7 +/- 1.1 pg/mL; IL-8, 4.2 +/- 1.3 pg/mL; TNF-alpha, 3.9 +/- 3.9 pg/mL). Our data suggest elevated plasma levels of proinflammatory cytokines may be useful as markers of bone resorption in the laboratory diagnosis of prosthesis loosening.