Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 2015
Randomized Controlled Trial Comparative StudyIs There an Advantage to Knotless Barbed Suture in TKA Wound Closure? A Randomized Trial in Simultaneous Bilateral TKAs.
Effective wound closure is critical to minimizing wound complications and withstanding the forces associated with early knee motion after TKA. Barbed sutures allow for knotless fixation, have been used successfully in other specialties, and may provide for more even distribution of tension along the length of the incision; however, data regarding unidirectional barbed sutures from randomized trials have raised important concerns about their use. Bidirectional barbed sutures offer a potential alternative, but have not been studied extensively in orthopaedic surgery. ⋯ Level I, therapeutic study.
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Clin. Orthop. Relat. Res. · Jun 2015
ReviewHow should we grade lumbar disc herniation and nerve root compression? A systematic review.
MRI is the gold standard for evaluating the relationship of disc material to soft tissue and neural structures. However, terminologies used to describe lumbar disc herniation and nerve root compression have always been a source of confusion. A clear understanding of lumbar disc terminology among clinicians, radiologists, and researchers is vital for patient care and future research. ⋯ The main issue in the management of patients with lumbar disc disease and nerve root compression is correlation of imaging findings with clinical presentation and symptomatology to guide treatment and intervention. Although it appears that the most commonly supported nomenclatures have strong interobserver reliability, the classification term "disc bulges" is a source of confusion and disagreement among many practitioners. Additional research should focus on the clinical application of the various nomenclatures.
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Clin. Orthop. Relat. Res. · Jun 2015
Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common.
Primary bone or soft tissue tumors of the femur sometimes present with severe and extensive bone destruction, leaving few limb-salvage options other than total femur replacement. However, there are few data available regarding total femur replacement and, in particular, regarding implant failures. ⋯ Level IV, therapeutic study.
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Clin. Orthop. Relat. Res. · Jun 2015
ReviewDo Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review.
As part of a comprehensive nonsurgical approach, epidural injections often are used in the management of lumbar disc herniation. Recent guidelines and systematic reviews have reached different conclusions about the efficacy of epidural injections in managing lumbar disc herniation. ⋯ The available evidence suggests that epidural injections performed under fluoroscopy by trained physicians offer improvement in pain and function in well-selected patients with lumbar disc herniation.