Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jan 2015
Comparative Study Observational StudyAbnormal quantitative sensory testing is associated with persistent pain one year after TKA.
Up to 15% of patients report at least moderate persistent pain after TKA. Such pain may be associated with the presence of widespread hyperalgesia and neuropathic-type pain. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Jan 2015
Infrapatellar saphenous neuralgia after TKA can be improved with ultrasound-guided local treatments.
Current opinion suggests that in some patients, chronic pain after total knee arthroplasty (TKA) has a neuropathic origin. Injury to the infrapatellar branch of the saphenous nerve (IPSN) has been implicated as a cause of medial knee pain; however, local treatments for this condition 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. · Jan 2015
Comparative StudySex-specific differences of the infraacetabular corridor: a biomorphometric CT-based analysis on a database of 523 pelves.
An infraacetabular screw path facilitates the closure of a periacetabular fixation frame to increase the plate fixation strength in acetabular fractures up to 50%. Knowledge of the variance in corridor sizes and axes has substantial surgical relevance for safe screw placement. ⋯ This study provided reference values for placement of a 3.5-mm cortical screw in the infraacetabular osseous corridor in 90% of female and 94% of male pelves. Based on the sex-related differences in corridor axes, the mean screw trajectory is approximately parallel to the sagittal midline plane in males but has to be tilted from medial to lateral in females. Considering the narrow corridor diameters, we suggest an individual preoperative CT scan analysis for fine adjustments in each patient.
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Clin. Orthop. Relat. Res. · Jan 2015
Has the incidence of thoracolumbar spine injuries increased in the United States from 1998 to 2011?
While most motor vehicle crash (MVC)-related injuries have been decreasing, one study showed increases in MVC-related spinal fractures from 1994 to 2002 in Wisconsin. To our knowledge, no studies evaluating nationwide trends of MVC-related thoracolumbar spine injuries have been published. Such fractures can cause pain, loss of functionality or even death. If the incidence of such injuries is increasing, it may provide a motive for reassessment of current vehicle safety design. ⋯ While other studies have shown that rates of many MVC-related injuries are declining with time, our data show increases in the incidence of thoracolumbar injury. Although more sensitive screening tools likely have resulted in earlier and increased recognition of these injuries, it cannot be stated for certain that this is the only driver of the increased incidence observed in this study. As seatbelt use has continued to increase, this trend may be the result of thoracolumbar injuries as trade-offs for other injuries, although in our study we did not see a compensatory decrease in sacropelvic injuries. Investigation evaluating the root of this pattern is warranted.
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Clin. Orthop. Relat. Res. · Jan 2015
The risk of revision after TKA is affected by previous HTO or UKA.
High tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) are reconstructive surgeries advocated for younger patients. In case of failure or progression of osteoarthritis, they can both be converted to a total knee arthroplasty (TKA). ⋯ Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.