Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2017
Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA.
Periprosthetic fractures of the acetabulum occurring during primary THA are rare. Periprosthetic occult fractures are defined as those not identified by the surgeon during the procedure which might be missed on a routine postoperative radiograph. However, it is unclear how frequently these fractures occur and whether their presence affects functional recovery. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Feb 2017
Randomized Controlled Trial Multicenter Study Comparative StudyOtto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty.
Length of stay after total hip arthroplasty (THA) has decreased over the last two decades. However, published studies that have examined same-day and early discharge protocols after THA have been done in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects. ⋯ Level I, therapeutic study.
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Clin. Orthop. Relat. Res. · Jan 2017
Is It Appropriate to Treat Sarcoma Metastases With Intramedullary Nailing?
Patients with primary bone and soft tissue sarcoma are at risk for skeletal metastases. Although uncommon, these metastases can result in impending or pathologic fractures. Intramedullary nailing traditionally has been an accepted form of palliative treatment for patients with metastatic carcinoma, but we could find no studies that report specifically on intramedullary nailing of metastatic sarcoma lesions. ⋯ Level IV, therapeutic study.
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Clin. Orthop. Relat. Res. · Jan 2017
Randomized Controlled Trial Multicenter Study Comparative StudyNo Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA.
Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction. There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks. ⋯ Level I, therapeutic study.
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Clin. Orthop. Relat. Res. · Jan 2017
Comparative StudyPain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block.
Although pain management after total knee arthroplasty (TKA) affects rehabilitation, length of stay, and functional outcomes, pain management for patients undergoing TKA has yet to be standardized. Femoral nerve blocks (FNBs) are commonly used as an adjunct; however, these can result in transient quadriceps weakness and have been associated with in-hospital falls. Periarticular infiltration of liposomal bupivacaine has been recently introduced as a long-acting analgesic that can be administered without affecting motor function. ⋯ Level III, therapeutic study.