Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 2015
ReviewIs sequestrectomy a viable alternative to microdiscectomy? A systematic review of the literature.
Traditionally, lumbar discectomy involves removal of the free disc fragment followed by aggressive or conservative excision of the intervertebral disc. In selected patients, however, it is possible to remove only the free fragment or sequester without clearing the intervertebral disc space. However, there is some controversy about whether that approach is sufficient to prevent recurrent symptoms and to provide adequate pain relief. ⋯ This review of the available literature suggests that, compared with conventional microdiscectomy, microsurgical lumbar sequestrectomy can achieve comparable reherniation rates and reduction in radicular pain when a small breach in the posterior fibrous ring is found intraoperatively.
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Clin. Orthop. Relat. Res. · Jun 2015
ReviewOutcomes of Lumbar Discectomy in Elite Athletes: The Need for High-level Evidence.
Although lumbar discectomy for treatment of lumbar disc herniation in the general population generally improves patients' pain, function, and validated outcomes scores, results of treatment in elite athletes may differ because of the unique performance demands required of competitive athletes. ⋯ A high proportion of elite athletes undergoing lumbar discectomy return to play with variable performance scores on return. Future prospective studies are needed to compare the recovery time, career longevity, and performance for athletes undergoing lumbar discectomy versus nonoperative treatment for lumbar disc herniation.
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Clin. Orthop. Relat. Res. · Jun 2015
ReviewDoes surgical timing influence functional recovery after lumbar discectomy? A systematic review.
The impact of the duration of preoperative symptoms on outcomes after lumbar discectomy has not been sufficiently answered in a single study but is a potentially important clinical variable. ⋯ Longer symptom duration had an adverse impact on results in most studies after lumbar discectomy. A possible point beyond which outcomes may be compromised is 6 months after symptom onset. Limitations in the literature surveyed, however, prevent firm conclusions.
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Clin. Orthop. Relat. Res. · Jun 2015
Comparative StudyComparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA.
Revision THA and TKA are growing and important clinical and economic challenges. Healthcare systems tend to combine revision joint replacement procedures into a single service line, and differences between revision THA and revision TKA remain incompletely characterized. These differences carry implications for guiding care and resource allocation. We therefore evaluated epidemiologic trends associated with revision THAs and TKAs. ⋯ These data could prove important for healthcare systems to appropriately allocate resources to hip and knee procedures: the revision burden for THA is 52% greater than for TKA, but revision TKAs are increasing at a faster rate. Likewise, the treating clinician should understand that while both revision THAs and TKAs bear significant clinical and economic costs, patients undergoing revision THA tend to be older, sicker, and have greater costs of care.
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Clin. Orthop. Relat. Res. · Jun 2015
Comparative StudyRecurrent Versus Primary Lumbar Disc Herniation Surgery: Patient-reported Outcomes in the Swedish Spine Register Swespine.
Lumbar disc herniation (LDH) is a common indication for lumbar spine surgery. The proportion of patients having a second surgery within 2 years varies in the literature between 0.5% and 24%, with recurrent herniation being the most common cause. Several studies have not found any relevant outcome differences between patients undergoing surgery for primary LDH and patients undergoing reoperation for a recurrent LDH, but these studies have limitations, including small sample size and retrospective design. ⋯ Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.