The Journal of arthroplasty
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There are currently few published studies examining the use of locking compression plates for the treatment of periprosthetic femoral fractures. Fifteen total hip or knee arthroplasty patients with 16 Vancouver type B1 and C fractures with an average age of 76 years were fixed and followed clinically and radiographically for 2 years. Fourteen patients achieved radiographic union by 6 months, and 13 patients were ambulatory by 6 months. ⋯ In summary, locking plates offer a viable treatment option for these difficult fractures. We advocate a minimum of 10 cortices of fixation (with unicortical or bicortical screws and cable combinations) above and below the fracture. Bone grafting should be used if the soft tissue envelope is violated with extensive dissection, and cortical struts should be considered in cases of failed hardware and revision fixation.
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Evaluation of hospital readmissions after total hip arthroplasty may help improve patient safety and cost reduction. This study investigates the rates and reasons for readmission as well as length of hospital stay (LOS) for 1802 total hip arthroplasty patients from 2002 to 2007. Data were abstracted from the Medicare Patient Safety Monitoring System. ⋯ The most common causes for readmission were cardiac related. A reduction in LOS was not associated with an increase in the rate of readmission in this sample. Efforts to optimize cardiac status before discharge may lead to lower rates of readmission in the future.
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Randomized Controlled Trial
Benefits of prolonged postoperative cyclooxygenase-2 inhibitor administration on total knee arthroplasty recovery: a double-blind, placebo-controlled study.
A double-blind, placebo-controlled study of a selective cyclooxygenase (COX)-2 inhibitor administered in 107 patients for 6 weeks after total knee arthroplasty was done to determine any benefits. All patients received celecoxib preoperatively and during hospitalization. At hospital discharge, patients were randomized to receive celecoxib or placebo for 6 weeks. ⋯ The celecoxib group used fewer narcotics and had significantly better visual analog scale scores, knee flexion, Knee Society Score scores, Oxford Knee Score scores, and Short-Form 12 physical composite scores than the placebo group. Knee flexion remained significantly improved through 1 year. These results demonstrate that patients who took celecoxib for 6 weeks after total knee arthroplasty had a less painful and more rapid recovery.
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Case Reports
Failure of larger-diameter metal-on-metal total hip arthroplasty resulting from anterior iliopsoas impingement.
Anterior iliopsoas impingement is a recognized cause of persistent groin pain after total hip arthroplasty. We report 3 patients with failed total hip arthroplasties resulting from anterior iliopsoas and capsular impingement secondary to a metal femoral ball with a diameter larger than the native femoral head. ⋯ Resolution of symptoms occurred in all patients after revision surgery. To our knowledge, this is the first report of this potential failure mechanism with these large-diameter implant designs and should be considered in the appropriate clinical scenario.
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One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-knee-ankle (HKA) angle of 172.2° ± 3.1° improved to 177.1° ± 2.9° postoperatively. ⋯ Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preoperative varus deformity had a tendency to remain in excessive varus, and limbs with lesser preoperative varus deformity had a greater tendency to go into valgus postoperatively.