Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 2011
The need for total hip arthroplasty in Perthes disease: a long-term study.
Legg-Calvé-Perthes disease (LCPD) was described a century ago. In previous long-term reports of patients with LCPD, nonoperative treatment varied considerably. The likelihood of hip osteoarthritis (OA) developing in patients with LCPD and possible need for THA are not well defined. ⋯ Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Apr 2011
Intraoperative molds to create an articulating spacer for the infected knee arthroplasty.
Chronic infections in TKA have been traditionally treated with a two-stage protocol incorporating a temporary antibiotic-loaded cement spacer. The use of a static as opposed to an articulating spacer is controversial. Some surgeons believe a static spacer results in a higher rate of infection eradication, whereas others believe an articulating spacer provides equivalent rates of infection control with improved function between stages and the potential for better eventual range of motion. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of "overstuffing," cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Apr 2011
Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty.
A two-stage revision total knee arthroplasty is recognized as the gold standard in the treatment of infection. However, traditional spacers limit function in the interval between the two stages and may cause instability, scarring, and bone erosion. The PROSTALAC knee spacer is an antibiotic-loaded cement articulating spacer that allows some movement of the knee between stages. Whether motion enhances long-term function is unknown. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Apr 2011
Articulating spacers used in two-stage revision of infected hip and knee prostheses abrade with time.
Articulating spacers used in two-stage revision surgery of infected prostheses have the potential to abrade and subsequently induce third-body wear of the new prosthesis. ⋯ The observations suggest cement spacers do abrade within 6 weeks. Given the presence of abrasion debris, we recommend total synovectomy and extensive lavage during the second-stage reimplantation surgery to minimize the number of abraded particles and any retained bacteria.