The Journal of arthroplasty
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This follow-up study reports on 69 patients at mean 13 years with total hip arthroplasty using 28-mm Metasul (Zimmer, Winterthur, Switzerland) metal-on-metal articulation. These results are not transferable to large-diameter head metal-on-metal articulations. ⋯ No revision was done for osteolysis. Overall, of the original 127 hips, 116 (91%) were known to have maintained their original components.
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We describe a case of a well-functioning total knee arthroplasty acutely infected with Clostridium septicum. This is the first reported infection of a prosthetic joint with this organism. ⋯ This organism is highly associated with gastrointestinal malignancy, and appropriate investigation should be carried out when it is discovered. The importance of full anaerobic bacterial identification by the microbiology laboratory is underscored by this case.
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We describe a case of successful revision total hip arthroplasty for a Vancouver type B3 periprosthetic femoral fracture with extensive bone stock deficiency and osteoporotic diaphyseal bone. The femur was reconstructed with an allograft-cemented stem composite using a telescoping technique and a drainage hole for surplus cement. This procedure facilitated stable stem fixation to the host femur without cement interference and bony fusion between the allograft and host bone, as revealed by bone scintigraphy. This technique provides a surgical option for a severe periprosthetic femoral fracture in which the femoral diaphyseal bone is too osteoporotic to support the fixation of an allograft-cementless stem composite.
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We assessed whether higher body mass index (BMI) is associated with higher risk of moderate-severe knee pain 2 and 5 years after primary or revision total knee arthroplasty (TKA). We adjusted for sex, age, comorbidity, operative diagnosis, and implant fixation in multivariable logistic regression. ⋯ Similarly, BMI was not associated with moderate-severe pain at 5-year primary TKA and at 2-year and 5-year revision TKA follow-up. Lack of association of higher BMI with poor pain outcomes post-TKA implies that TKA should not be denied to obese patients for fear of suboptimal outcomes.
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Case Reports
Peroneal nerve dysfunction after total knee arthroplasty: characterization and treatment.
The purpose of this study was to report on the presentation, evaluation, treatment, and outcome of patients who had a peroneal nerve dysfunction after total knee arthroplasty. Six patients were unable to achieve adequate range of motion after physical therapy, and the remaining 5 patients had sensory symptoms that interfered with daily activities despite adequate range of motion. ⋯ All patients with dominant sensory symptoms had a resolution of leg and foot pain after treatment. Orthopedic surgeons should be aware of peroneal nerve dysfunction as a possible cause of unsatisfactory rehabilitation and/or persistent atypical lateral leg pain after total knee arthroplasty.