Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 1991
ReviewA clinical perspective on common forms of acquired heterotopic ossification.
The clinical courses of heterotopic ossification (HO) as a consequence of trauma and central nervous system insults have many similarities as well as dissimilarities. Detection is commonly noted at two months. The incidence of clinically significant HO is 10%-20%. ⋯ Surgical timing differs according to etiology: traumatic HO may be resected at six months; spinal cord injury HO is excised at one year; and traumatic brain injury HO is removed at 1.5 years. A small number of patients have progression of HO with medicinal treatment and recurrence after resection. The patients seem recalcitrant to present treatment methods regardless of the HO etiology.
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Clin. Orthop. Relat. Res. · Jan 1991
Growth disturbance in Legg-Calvé-Perthes disease and the consequences of surgical treatment.
Seventy-two patients with Legg-Calvé-Perthes disease were studied to assess the interference with proximal femoral growth as a result of the disease itself and of surgical treatment. Twenty-five patients were treated nonoperatively, 20 were treated by femoral varus derotation osteotomy, and 27 by innominate osteotomy. All patients were studied clinically for evidence of abductor weakness and leg-length discrepancy. ⋯ A significantly lower mean ATD was found in patients treated by femoral varus osteotomy, which should be avoided in patients over eight years of age. The study also demonstrated a strong association between coxa magna and growth disturbance of the proximal femoral physis manifesting itself as either a leg-length discrepancy or as a low ATD. The significant effects of growth disturbance after treatment must be considered, as well as the sphericity of the healed femoral head, in the final assessment in Legg-Calvé-Perthes disease.
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Clin. Orthop. Relat. Res. · Dec 1990
Cementless total joint arthroplasty prostheses with titanium-alloy articular surfaces. A human retrieval analysis.
Surgical implants of titanium alloy (Ti-6Al-4V) have been found to be susceptible to abrasive wear, resulting in the well-known phenomenon of metallosis. In the presence of the acrylic debris generated by loose joint arthroplasty prostheses, this abrasive wear is greatly increased. However, the bone loss seen in these cases has generally been presumed to be due to the osteolytic effects of particulate acrylic, not the alloy debris, which has generally been assumed to be biocompatible. ⋯ Visible burnishing was observed on every articular surface, with a linear relationship between wear and time implanted. By one year the surfaces were covered with a characteristic "scratch and gouge" pattern, similar on all sizes of femoral heads as well as the total knee prostheses. This study demonstrates that the combination of Ti-6Al-4V alloy and UHMWPE, when used as a bearing surface combination in total joint arthroplasty prostheses, results in excessive wear of both metal and polymer.(ABSTRACT TRUNCATED AT 400 WORDS)
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The prognosis for peroneal palsy after total knee arthroplasty (TKA) is poorly defined. Twenty-six postoperative peroneal palsies occurred after 8998 TKAs performed between 1972 and 1985. Eighteen patients had complete and eight had incomplete peroneal palsies. ⋯ Complete recovery was more likely in those palsies that were incomplete initially. Patients with palsies that were initially partial had significantly higher knee scores than those with complete palsies, and patients whose eventual recovery was complete had significantly higher knee scores than those with incomplete recovery. This new prognostic information should be useful for surgeons who encounter this unfortunate yet persistent complication of TKA.
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Clin. Orthop. Relat. Res. · Nov 1990
Comparative StudyThe effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty.
Efficacies of three alternate methods of postoperative analgesia were studied in 156 patients who had total knee arthroplasty (TKA). Forty-two of these patients received parenteral meperidine hydrochloride or morphine (Group 1), 58 patients received periodic epidural injections of morphine (Group 2), and 56 patients received continuous epidural infusions of bupivacaine hydrochloride and Duramorph (Group 3). The postoperative course of all patients was documented in terms of the incidence and severity of pain, range of joint motion, duration of hospitalization, and occurrence of complications. ⋯ However, the use of epidural analgesia did not reduce the incidence of complications, including nausea. Continuous infusion of epidural bupivacaine and Duramorph provided good-to-excellent control of postoperative pain after TKA. However, better analgesics are needed to reduce the high incidence of side effects associated with various treatment methods.