Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Nov 2000
Randomized Controlled Trial Clinical TrialProspective randomized clinical trial of continuous passive motion after total knee arthroplasty.
The authors report the results of a prospective randomized clinical trial using continuous passive motion after total knee arthroplasty. One hundred twenty patients were assigned randomly to one treatment group: No continuous passive motion (Group I), continuous passive motion from 0 degrees to 50 degrees and increased as tolerated (Group II), and continuous passive motion from 70 degrees to 110 degrees (Group III). The continuous passive motion was initiated in the recovery room and was maintained for a maximum of 24 hours at which point all patients began identical postoperative physiotherapy regimens. ⋯ There were no statistical differences between any of the treatment groups regarding cumulative analgesic requirements, range of motion at any measured interval, length of stay (Group I, 5.1 days; Group II, 5.2 days; Group III, 5 days) or Knee Society scores. The current study does not support the use of short-term continuous passive motion after total knee replacement. A standard and a high flexion continuous passive motion protocol failed to show any advantage over physiotherapy alone in the parameters evaluated.
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Clin. Orthop. Relat. Res. · Nov 2000
Randomized Controlled Trial Clinical TrialThe role of bladder catheterization in total knee arthroplasty.
The use of a urinary bladder catheter in the perioperative period for patients undergoing total knee arthroplasty is controversial. In the current study, two bladder management protocols were studied. One group of patients had an indwelling catheter inserted into the bladder before total knee arthroplasty. ⋯ A urinary tract infection did not develop in any patient in whom a straight catheter was inserted. There was no significant difference in the length of stay in the hospital between the two groups. The group in whom a catheter always was inserted generated $491 greater cost for total knee arthroplasty than patients in whom a catheter was inserted if necessary.
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Clin. Orthop. Relat. Res. · Oct 2000
Comparative StudyBipolar versus total hip arthroplasty for hip osteonecrosis in the same patient.
The authors studied 28 patients with bilateral avascular necrosis of the femoral head who were treated with a cementless bipolar endoprosthesis in one hip and cementless total hip arthroplasty in the other. All the hips selected for bipolar endoprostheses were classified as having avascular necrosis of the femoral head Ficat Stage III, and all the hips selected for total hip arthroplasty were classified as having Ficat Stage IV avascular necrosis. After a midterm followup of an average of 6.4 years (range, 4-12 years), 24 of 28 hips that received bipolar endoprostheses were considered satisfactory, whereas 23 of 28 hips in which an arthroplasty was done were considered satisfactory. ⋯ There were no statistical differences in both groups in terms of clinical result, thigh pain, groin pain, osteolysis, dislocation, and revision rate. Total hip arthroplasty is not the preferred treatment for all patients with hip osteonecrosis. In young patients with Ficat Stage III osteonecrosis with Grade 0 or Grade I cartilage, the use of a cementless bipolar endoprosthesis with a bone ingrowth stem may be considered as an alternative to total hip arthroplasty.
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The origins of informed consent come from philosophy, medical experimentation, the law, and contemporary trends in doctor and patient relationships. Every surgical patient signs an informed consent form but the literature would suggest that many times there is incomplete information conveyed by the physicians or understood by the patient. Informed consent should be considered as an expression of respect for patient autonomy and the patient education necessary for a truly informed consent should be considered a surgical virtue.
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Clin. Orthop. Relat. Res. · Aug 2000
Comparative StudyA biomechanical comparison of Schuhli nuts or cement augmented screws for plating of humeral fractures.
Schuhli locking nuts can be used in poor quality cortical bone to enhance fixation stability as an alternative to cement augmented screws. This study compared the fixation strength and stability of plate constructs using Schuhli locking nuts with standard screws and cement augmented screws for fixation of simulated humeral shaft fractures in a test model with osteoporosis. The constructs were tested in axial compression, 4-point bending, and torsion to determine fixation stability. ⋯ Although cement augmented screws and Schuhli augmentation showed increased fixation stability compared with the standard screws in axial and 4-point bending before cycling (range, 1.3-1.4 times greater), this was not significant. Compared with Schuhli fixation, cement augmented screws showed no significant difference in fixation stability in all loading modes before and after cycling. Schuhli locking nuts offer the stability of cement augmentation while avoiding its potential adverse effects on fracture healing with extravasation and thermal necrosis.