Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2016
What Are the Functional Outcomes After Total Sacrectomy Without Spinopelvic Reconstruction?
After total sacrectomy, many types of spinopelvic reconstruction have been described with good functional results. However, complications associated with reconstruction are not uncommon and usually result in further surgical interventions. Moreover, less is known about patient function after total sacrectomy without spinopelvic reconstruction, which may be indicated when malignant or aggressive benign bone and soft tissue tumors involved the entire sacrum. ⋯ Level IV, therapeutic study.
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Clin. Orthop. Relat. Res. · Feb 2016
Review Meta AnalysisIs Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis.
Local infiltration analgesia and peripheral nerve blocks are common methods for pain management in patients after THA but direct head-to-head, randomized controlled trials (RCTs) have not been performed. A network meta-analysis allows indirect comparison of individual treatments relative to a common comparator; in this case placebo (or no intervention), epidural analgesia, and intrathecal morphine, yielding an estimate of comparative efficacy. ⋯ Level I, therapeutic study.
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Clin. Orthop. Relat. Res. · Feb 2016
Multicenter Study Comparative StudyIs There a Benefit to Modularity in 'Simpler' Femoral Revisions?
Modular revision femoral components allow the surgeon to make more precise intraoperative adjustments in anteversion and sizing, which may afford lower dislocation rates and improved osseointegration, but may not offer distinct advantages when compared with less expensive monoblock revision stems. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Feb 2016
Comparative StudyCan Radiographs Predict the Use of Modular Stems in Developmental Dysplasia of the Hip?
Abnormal anatomy frequently results in the use of a modular stem in patients undergoing primary total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). However, because these stems are not always available in the operating room, it would be helpful if standard radiographic views could be analyzed in such a way that patients whose femoral anatomy might call for stem modularity could be anticipated before surgery. To our knowledge, no such parameters have been defined. ⋯ Preoperative radiographs anticipated the use of modular stems during THA for DDH in a practice where modular stems were chosen on the basis of a neck-shaft angle of greater than 25° measured at surgery. We found that this could be predicted on preoperative radiographs based on smaller lateral neck-shaft angles, steeper AP radiographic neck-shaft angles, and increased femoral anteversion calculated using these angles. Prospective studies are needed to better determine if these cutoff values adequately predict the use of modular stems.
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Clin. Orthop. Relat. Res. · Feb 2016
Risk of Post-TKA Acute Myocardial Infarction in Patients With a History of Myocardial Infarction or Coronary Stent.
Acute myocardial infarction (AMI) is one of the most important perioperative complications of total knee arthroplasty (TKA). Although risk-stratification tools exist for the prediction of cardiac complications including AMI after noncardiac surgery, such stratification does not differentiate the patients with a coronary stent alone, AMI without a stent, or AMI with a stent. The risk of postoperative AMI in these patient groups may vary. Several studies have recommended suitable times for noncardiac surgery in patients with a coronary stent; however, they do not differentiate between the patients with AMI and no AMI. The suitable time of noncardiac surgery for patients with AMI and stent may vary from those with a stent alone. Moreover, a study to evaluate the risk of AMI within 1 year in an Asian population with a history of AMI or coronary stent who underwent TKA has not been reported. ⋯ Level III, prognostic study.