Orthopedics
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The purpose of this study was to evaluate the accuracy of alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. A prospective case series of 56 consecutive patients underwent open-wedge high tibial osteotomy fixed with a TomoFix plate fixator (Synthes, West Chester, Pennsylvania). The correction angle was radiologically determined preoperatively and at 6 months postoperatively. ⋯ Undercorrection was associated with a significantly lower clinical outcome in comparison to the accurate correction and overcorrection. Ligamentous laxity or soft tissue slackness of the knee can influence the overall correction after high tibial osteotomy and must be considered in preoperative planning. Patients with a high body mass index had inferior clinical results after open-wedge high tibial osteotomy.
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Review Meta Analysis Comparative Study
Systematic review and meta-analysis of randomized controlled trials: comparison of total disk replacement with anterior cervical decompression and fusion.
The authors performed a systematic review and meta-analysis to evaluate whether there is a beneficial clinical effect of total disk replacement compared with anterior cervical diskectomy and fusion for the treatment of single-level symptomatic cervical disk disease. A comprehensive literature search of multiple databases, including PubMed (1966-2011), Cochrane Controlled Trials Register (CENTRAL; issue 1, 2011), and Embase (1984-2011), was conducted to identify studies that met the inclusion criteria. Methodologic quality was assessed and relevant data were retrieved, and if appropriate, meta-analysis was performed. ⋯ Other outcomes, including Neck Disability Index scores (SMD, -.02; CI, -.44 to .27; P=.67) and visual analog scale arm pain scores (SMD, -.21; CI, -.63 to .22; P=.34), demonstrated no differences between the 2 groups. For patients with single-level symptomatic cervical disk disease, total disk replacement was found to be more effective than anterior cervical diskectomy and fusion in the 2 outcomes of overall success rate and overall reoperation rate at 24 months. Long-term results also showed total disk replacement trended to be more effective than anterior cervical diskectomy and fusion in some aspects.
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Multicenter Study Clinical Trial
Influence of the position of the fibular head after implantation of a total knee prosthesis on femorotibial rotation.
A gold standard for the correct rotation of the tibial component has not been established in total knee arthroplasty (TKA). The target parameter of correct rotation is the facilitation of femorotibial rotation over the entire range of motion with no implant overhang. Although the origin of the lateral collateral ligament is a recognized landmark for determining the rotation of the femoral component (epicondylar axis), the attachment of the lateral collateral ligament has not been taken into consideration for adjusting tibial rotation until now. ⋯ The angle between the surgical epicondylar axis and the line from tibial tuberosity to tibial center was 69°±8.3°. This close correlation (R=.73; P<.001) shows that the position of the fibular head determines femorotibial rotation. The fibular head may become a helpful landmark for establishing the rotation of the tibial component; it could be useful in interpretation of postoperative CT scans in knees suspected of tibial malrotation.
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Review
Novel oral anticoagulants for VTE prevention in orthopedic surgery: overview of phase 3 trials.
Outpatient use of anticoagulants to prevent venous thromboembolism after total hip or knee arthroplasty may be hampered either by requirements for parenteral administration or high variability and frequent monitoring of anticoagulant activity. Trials of the new oral direct factor Xa inhibitors rivaroxaban and apixaban and the direct thrombin inhibitor dabigatran indicate that they can be administered in fixed doses without monitoring and that they generally have efficacy at least equivalent to enoxaparin, although with potential minor differences in the balance of efficacy vs risk for bleeding. This article reviews the results and pharmacokinetic properties that may influence their use in clinical practice.
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Surgical treatment of 3- and 4-part proximal humeral fractures remains challenging. This study retrospectively evaluated functional outcomes of locked plate fixation vs hemi-arthroplasty in 57 patients with 3- and 4-part proximal humerus fractures from 2003 to 2005 with a mean follow-up time of 35 months (range, 15.7-52.7 months). Mean patient age was 56.9 years (range, 29-81.7 years) for the open reduction and internal fixation group (n=42) and 66.4 years (range, 38.1-90 years) for hemiarthroplasty group (n=15). ⋯ In the hemiarthroplasty group, there was 1 revision for a loose prosthesis. The American Shoulder and Elbow Surgeons score (P=.023), Simple Shoulder Test (P=.012), patient satisfaction (P=.034), Constant Score (P=.008), Kelsh Adjusted Constant Score (P=.015), UCLA Shoulder score (P=.01), and range of motion (forward flexion, P=.002; abduction, P=.001) were significantly better in the open reduction and internal fixation group than the hemiarthroplasty group. No significant differences between the groups existed in terms of SF-12 (physical, P=.118; mental, P=.134), Euroqol EQ-5D [corrected] (P=.169), or visual analog pain scale scores (P=.135), but all trended toward better with open reduction and internal fixation.