Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2000
Posterolateral and anterior interbody spinal fusion models in the sheep.
Posterolateral and anterior interbody spinal arthrodesis is a frequent procedure, but high nonunion rates are reported and harvesting autologous bone graft from the iliac crest significantly increases morbidity. Bone graft substitutes are an alternative, but to date clinical results are not conclusive. Bone substitutes can be organic or inorganic, biologic or synthetic. ⋯ All fusions had bone cortex and good trabecular connectivity. Histologic evaluation suggests after 20 weeks nearly the entire surface of the substitute is covered with new bone. Porous mineral bone substitutes mixed with locally harvested autologous bone are thought to be a valid alternative for posterolateral fusions.
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Clin. Orthop. Relat. Res. · Jan 2000
Comparative StudyOccult hypoxia after femoral neck fracture and elective hip surgery.
The incidence of hypoxia after femoral neck and total hip arthroplasty was investigated. In addition, the incidence of preoperative and postoperative delirium was assessed. Oxygen saturation and mental status were tested before and after surgery in patients undergoing surgery for a femoral neck fracture or total hip arthroplasty. ⋯ Although the scores for the patients with femoral neck fractures were lower, delirium developed in only three patients with total hip replacements and six patients with femoral neck fracture. Hypoxia after hip surgery, particularly after femoral neck fracture, is common. The incidence of delirium was much lower than reported previously, and it is suggested that supplemental oxygen, when indicated and monitored by pulse oximetry, was the cause for the reduction in delirium.
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Clin. Orthop. Relat. Res. · Dec 1999
Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty.
Obtaining predictable, stable fixation of revision femoral implants is important for the long-term success of revision hip arthroplasty. The authors report on minimum 10 years clinical and radiographic followup of 170 patients with extensively coated cementless revision femoral components. With a range of followup of 10 to 16 years and a mean of 13.2 years, a survivorship of greater than 95% was reported. ⋯ Stress shielding was greatest in patients with stems larger than 16.5 mm and in osteoporotic bone (Dorr Type C). Nine percent of patients had significant thigh pain including all of the patients with unstable stems. In the presence of bone loss in the proximal metaphyseal region of the femur, fixation of the femoral component is predictable when optimizing prosthetic-bone fit in the diaphyseal region of the femur using an extensively coated femoral component.
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Sepsis after total joint replacement is related directly to environmental contamination. Therefore, to control the source of environmental contamination, and ultimately sepsis, it must be realized that the operating room personnel are the major source of the bacteria as evidence by the rise in the colony forming units per square foot per hour from 13 units in an operating room without people to greater than 400 units during actual surgery. The use of inclusive gowns, such as hooded body exhaust, is most helpful. ⋯ Face masks and head covers offer no environmental protection. Some type of an environmental control, such as laminar airflow or ultraviolet light, is the most helpful with greater than 90% reduction of airborne bacteria at the wound and 60% reduction of airborne bacteria in the operating room. Therefore, to reduce environmental bacteria contamination the number of personnel in the operating room and the length of time for the actual surgery should be reduced, because wound contamination occurs first by direct fall out from the environment and second by contaminated equipment and gloved hands that initially were contaminated by the environment.
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Clin. Orthop. Relat. Res. · Dec 1999
Analgesia with femoral nerve block for anterior cruciate ligament reconstruction.
Anterior cruciate ligament reconstruction is performed routinely as an outpatient surgical procedure despite few studies of patient acceptance or postoperative patient analgesia. This study reports the first series of postoperative femoral nerve blocks as analgesia for outpatient anterior cruciate ligament reconstruction. The authors retrospectively reviewed 161 patients undergoing two incision arthroscopically assisted autograft middle 1/3 patellar tendon anterior cruciate ligament reconstruction on an out-patient basis at the authors' institution during a period of 30 months. ⋯ However, 69% of patients staying overnight cited reasons other than pain as factors in their stay. No significant complications were reported. Based on these results, the administration of a femoral nerve block is recommended for patients undergoing outpatient anterior cruciate ligament reconstruction because it is a highly effective form of analgesia with an excellent degree of patient satisfaction.