Bulletin of the NYU hospital for joint diseases
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Bull NYU Hosp Jt Dis · Jan 2011
Correlation between nutritional status and Staphylococcus colonization in hip and knee replacement patients.
Orthopaedic patients with poor nutritional status are at an increased risk of postoperative complications, such as infection and wound healing. Nasal colonization with Staphylococcus aureus, especially with methicillin-resistant Staphylococcus aureus, has been shown to be a risk factor for surgical-site infections. We examined the incidence of nutritional depletion in our arthroplasty population and its correlation with Staphylococcus aureus colonization. ⋯ Six hundred and fifty-two patients underwent arthroplasty and completed preoperative nasal cultures and nutritional assessment. A high percentage (27%) of our patients demonstrated some level of nutritional depletion prior to joint replacement. Overall nutritional scores were not significantly associated with surgery-type, preoperative nasal culture, or surgical- site infection in our patient population.
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The causes of brachial plexus palsy in neonates should be classified according to their most salient associated feature. The causes of brachial plexus palsy are obstetrical brachial plexus palsy, familial congenital brachial plexus palsy, maternal uterine malformation, congenital varicella syndrome, osteomyelitis involving the proximal head of the humerus or cervical vertebral bodies, exostosis of the first rib, tumors and hemangioma in the region of the brachial plexus, and intrauterine maladaptation. ⋯ The probability of obstetrical brachial plexus palsy is directly proportional to the magnitude, acceleration, and cosine of the angle formed by the direction of the vector of the stretching force and the axis of the most vulnerable brachial plexus bundle, and inversely proportional to the resistance of the must vulnerable brachial plexus bundle and of the shoulder girdle muscles, joints, and bones. Since in most nonsurgical cases neither the contribution of each of these factors to the production of the obstetrical brachial plexus palsy nor the proportion of traction and propulsion contributing to the stretch force is known, we concur with prior reports that the term of obstetrical brachial plexus palsy should be substituted by the more inclusive term of birth-related brachial plexus palsy.
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Bull NYU Hosp Jt Dis · Jan 2011
ReviewAdverse soft-tissue reactions around non-metal-on-metal total hip arthroplasty - a systematic review of the literature.
Adverse local soft-tissue reactions have been associated with severe osteolysis and implant failure in metal-on-metal total hip arthroplasty (THA). Such a causal relationship has not often been associated with non metal-on-metal bearing surfaces. The purpose of this study was to assess the literature for cases of adverse soft-tissue reactions in non-metal-on-metal bearings in order to determine if a consistent histological diagnosis existed and if it was bearing-specific. ⋯ The present analysis revealed that similar adverse soft-tissue reactions have been described for both metal-on-polyethylene and ceramic bearing surfaces. When encountering such reactions in patients, a comprehensive diagnostic workup, including computed tomography (CT) scanning, lesion biopsy, and revision planning to alternate bearing surfaces should be considered.
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Bull NYU Hosp Jt Dis · Jan 2011
Comparative StudyThe outcomes of Cormet hip resurfacing compared to standard primary total hip arthroplasty.
Metal-on-metal hip resurfacing has provided an alternative to standard total hip arthroplasty in younger, more active patients. However, detractors argue that many of the benefits of resurfacing can be obtained with the use of larger femoral heads. The purported advantages of the resurfacing procedure include preservation of femoral bone stock, increased range of motion, decreased dislocation rate, excellent performance in high-activity patients, and a potentially easier revision than total hip arthroplasty. The purpose of this study was to examine the outcomes of patients who had hip resurfacing and to compare them to all total hip arthroplasty procedures performed during the same time period. ⋯ Excellent results continue to be demonstrated with hip resurfacing systems, with equal, early survivorship when compared to total hip arthroplasty. For patients who meet the appropriate selection criteria and in the hands of an experienced, high-volume arthroplasty surgeon hip resurfacing provides excellent early results.
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The issue of athletic participation after hip and knee arthroplasty has become more relevant in recent years, with an increase in the number of young and active patients receiving joint replacements. This article reviews patient-, surgery-, implant-, and sports-related factors, and discusses currently available guidelines that should be considered by the physician when counseling patients regarding a return to athletic activity after total joint arthroplasty. Current evidence regarding appropriate athletic participation after total hip arthroplasty, resurfacing hip arthroplasty, total knee arthroplasty, and unicondylar knee arthroplasty is reviewed.