The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2008
Risk factors for surgical site infection following orthopaedic spinal operations.
Surgical site infections are not uncommon following spinal operations, and they can be associated with serious morbidity, mortality, and increased resource utilization. The accurate identification of risk factors is essential to develop strategies to prevent these potentially devastating infections. We conducted a case-control study to determine independent risk factors for surgical site infection following orthopaedic spinal operations. ⋯ Diabetes was associated with the highest independent risk of spinal surgical site infection, and an elevated preoperative or postoperative serum glucose level was also independently associated with an increased risk of surgical site infection. The role of hyperglycemia as a risk factor for surgical site infection in patients not previously diagnosed with diabetes should be investigated further. Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of surgical site infection after spinal operations.
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J Bone Joint Surg Am · Jan 2008
Randomized Controlled TrialComputer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study.
There is little information on the feasibility of computer navigation when using a minimally invasive approach for total knee arthroplasty, during which the anatomic landmarks for registration may be obscured. The purpose of the present study was to determine the radiographic accuracy of this technique and to compare the rate of functional recovery between patients who underwent computer-assisted minimally invasive arthroplasty and those who underwent conventional total knee arthroplasty. ⋯ Although specific clinical parameters reflect an early increased rate of functional recovery in association with computer-assisted minimally invasive total knee arthroplasty within the first postoperative month, the main advantage of this technique over conventional total knee arthroplasty is improved postoperative radiographic alignment without increased short-term complications.
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J Bone Joint Surg Am · Jan 2008
The impact of trauma-center care on functional outcomes following major lower-limb trauma.
Although studies have shown that treatment at a trauma center reduces a patient's risk of dying following major trauma, important questions remain as to the effect of trauma centers on functional outcomes, especially among patients who have sustained major lower-limb trauma. ⋯ This study provides evidence that patients who sustain high-energy lower-limb trauma benefit from treatment at a level-I trauma center.
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J Bone Joint Surg Am · Jan 2008
Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age.
Cementless humeral resurfacing arthroplasty is a bone-conserving arthroplasty option for patients with glenohumeral arthritis. It has been successful in the older patient population. However, data regarding the results of arthroplasty in younger, more active patients are lacking. We report the two-year results of this procedure in active patients who were less than fifty-five years of age. ⋯ Cementless humeral resurfacing arthroplasty is a viable treatment option for younger, active patients. Early results indicate that the desired function and pain relief can be expected. Implant loosening and glenoid wear do not appear to be concerns in the short term despite the high activity levels of many patients. Long-term follow-up is needed to determine if these results persist.
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J Bone Joint Surg Am · Jan 2008
Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis.
The mobile-bearing feature of the Oxford unicompartmental knee replacement has the potential to optimize polyethylene wear, thereby leading to longer-term function of the implant. The function of the bearing requires intact soft tissues, with the ligaments being balanced throughout the range of motion intraoperatively through bone resection only. Final limb alignment is determined by the restored soft-tissue tension. The purposes of this study were to determine the limb alignment achieved in the absence of ligament release and to investigate the interplay of failure mode, survivorship, and limb alignment. ⋯ With this unicompartmental knee arthroplasty, the mechanical limb alignment resulting from balancing the knee ligaments, accomplished without releasing them, was consistently through the center of the knee. Progression of arthritis in the lateral compartment was the most common reason for late failure in this series and was not related to the initial postoperative alignment.