Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Apr 2002
Case ReportsComplications of joint arthroplasty in patients with end-stage renal disease on hemodialysis.
The mortality and morbidity after hip and knee arthroplasty were reviewed retrospectively during a 3-year period in 14 patients who had chronic renal failure and who were receiving hemodialysis. The patients had a primary total hip or knee replacement, or a revision arthroplasty or resection arthroplasty. Four of the patients (29%) died in the hospital during the postoperative period. ⋯ The results indicate that arthroplasty procedures, especially revisions and resections, in this patient population are associated with a high rate of complications and death, and that in-depth informed consent should be provided for all patients contemplating these procedures. Meticulous treatment of medical comorbidities is mandatory. Finally, data in the literature and in the current report question whether joint arthroplasty procedures should be done in patients with end-stage renal disease who are receiving hemodialysis.
-
Clin. Orthop. Relat. Res. · Apr 2002
Case ReportsBilateral congenital subtalar dislocation: a case report.
Fixed bilateral congenital subtalar dislocations were identified in a 2.5-year-old boy. The patient had been treated previously with a short-leg cast on each foot for 2 months. On presentation the patient ambulated on the medial malleoli and medial aspects of his feet. ⋯ The patient's subtalar range of motion is normal. Radiographic alignment is near normal without degenerative changes. To the authors' knowledge, there has been no previous report of this condition in the literature.
-
Although continuous infusion of local anesthetic through nerve sheath catheters provides excellent pain control after amputation, the influence of this technique on the incidence of phantom limb pain is controversial. The current retrospective study examined the influence of continuous nerve sheath catheter analgesia and primary anesthetic technique (general or regional anesthesia) on the incidence of phantom limb pain. After institutional review board approval, data were gathered on patients who had amputation from 1990 to 1999. ⋯ Incidence of phantom limb pain was higher for patients requiring proximal versus distal amputations. The primary anesthetic technique (general versus regional) did not affect the incidence of phantom limb pain. Long-term followup showed that the incidence of phantom limb pain in patients receiving continuous nerve sheath catheter infusion is lower than previously reported for patients who had amputation for oncologic indications.
-
Clin. Orthop. Relat. Res. · Mar 2002
Bone grafting of cryosurgically treated bone defects: experiments in goats.
It is hypothesized that cryosurgically treated bone defects are inappropriate host sites for cancellous bone grafting. The influence of autologous cancellous bone grafting on the healing of cryosurgically treated gap defects of long bones was investigated. A unilateral in vivo experiment was done to study bone strength and graft incorporation in the goat. ⋯ In all goats euthanized at 10 weeks or later, the graft was resorbed. The amount of bone apposition at the site of the cryosurgical lesion and the time at which the defect was bridged were similar in both groups. Autologous cancellous bone grafting does not accelerate healing of cryosurgically treated, stable, diaphyseal defects in the goat.
-
Clin. Orthop. Relat. Res. · Mar 2002
Perioperative ulnar neuropathy in orthopaedics: association with tilting the patient.
The incidence and causes of perioperative ulnar neuropathy in a prospective series of 203 consecutive patients were examined. Three percent of patients had ulnar neuropathy develop in the entire prospective series. ⋯ There was a highly significant association between a tilted body position on the operating table and development of ulnar neuropathy on the contralateral side. This position rotates the arm internally and places the ulnar nerve at risk for direct compression.