Orthopedics
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Randomized Controlled Trial Comparative Study
Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial.
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Randomized Controlled Trial
Do microfractures improve high tibial osteotomy outcome?
The aim of this study was to determine if microfractures improve the outcome of high tibial osteotomy in patients with medial compartmental osteoarthritis in genu varum. Forty patients presenting with Outerbridge grade III and IV chondropathies on the femoral and/or the tibial joint surface underwent high tibial osteotomy with Puddu plates (Arthrex, Inc, Naples, Florida) for primary medial compartment osteoarthritis in genu varum at our institution. Patients were randomly assigned to either the high tibial osteotomy plus microfractures group (A; n=20) or the high tibial osteotomy alone group (B; n=20). ⋯ Regarding the satisfaction score, there were no differences between the 2 groups in terms of preoperative self-assessment (P>.05), whereas postoperative subjective satisfaction at 5-year follow-up was significantly higher in group A than in group B (P=.0036). Our study results provide further evidence that medial tibial osteotomy is an effective surgical option for treating a varus knee associated with medial degenerative arthritis in patients wishing to continue accustomed levels of physical activity. In particular, patient satisfaction was higher among those who underwent the combined treatment involving high tibial osteotomy to correct femorotibial angle and microfractures.
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Randomized Controlled Trial
Effect of a perioperative intra-articular injection on pain control and early range of motion following bilateral TKA.
Pain control after total knee arthroplasty (TKA) is integral in the immediate postoperative period for early rehabilitation. Numerous different methods of postoperative analgesia are available, but each has its own risk of adverse side effects. This study was performed to prospectively evaluate the benefits of an intra-articular analgesic injection in patients undergoing bilateral TKA. ⋯ Each patient acted as his or her own internal control. The pharmacologically injected knee had statistically significantly less pain immediately postoperatively when compared to the control knee and displayed significantly increased range of motion within the first week of rehabilitation. The use of an intraoperative intra-articular injection with the above drug combination significantly reduces patient pain and increases postoperative mobility with no apparent risks following bilateral TKA.
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Randomized Controlled Trial
Short-term outcome of bilateral decompression via a unilateral paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation.
The purpose of this study was to evaluate the clinical and radiologic outcomes of bilateral decompression via a unilateral paramedian approach for transforaminal lumbar interbody fusion. Forty consecutive patients satisfying the inclusion criteria were divided randomly into groups 1 and 2. Patients were treated with unilateral (group 1) or bilateral (group 2) pedicle screw fixation and bilateral decompression via 1-sided (group 1) or bilateral (group 2) paramedian approach. ⋯ No significant differences were seen in the improvements of the ODI, JOA, and VAPS values between groups 1 and 2 at any postoperative time point. Postoperative CT indicated that the contralateral decompression was sufficient in both groups. The short-term results indicate that bilateral decompression via a unilateral paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation is safe, feasible, and effective over the short-term and is more cost-efficient than a bilateral paramedian approach.
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Randomized Controlled Trial
Pain control infusion pumps: a prospective randomized evaluation in bilateral total knee arthroplasty.
We prospectively monitored pain scores on 24 patients who underwent bilateral total knee arthroplasty (TKA). Patients were blinded to receiving either a functional or placebo pain control infusion pumps. After 3 days, pump volume was recorded, and patients were asked to identify which knee they believed received the functional pain control infusion pump. ⋯ Pump volumes ranged from 70 to 310 mL, with an average flow rate of 4.3 mL/hour. Positive identification rates were similar to rates routinely generated from standard placebo symptom treatment pain trials (0%-60%). Our data suggest that the placebo effect plays at least a partial role in pain control infusion pump effectiveness, and that pain control infusion pump use for TKA unpredictably contributes to postoperative pain management. [corrected]