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debate arthroplasty

Louis F McIntyre
A considerable body of literature with high-level evidence has been published in the past 15 years calling into question the value of arthroscopic surgery in treating osteoarthritis of the knee (OAK). This, plus recent guidelines advising against the use of conservative treatments such as hyaluronic viscosupplementation, threatens to limit patient access to treatment for a chronic disease state with no known cure. The disease burden of OAK is considerable and represents one of the largest health care dollar expenditures in the United States and the world...
March 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Christopher J Sardon, Mathew L Resnick
BACKGROUND: Acetabular labral tears in the hip have become an increasingly common finding in active duty members due to improved diagnostic capabilities. This has led to a dramatic increase in operative management despite a lack of evidence to support clear long-term benefits. Literature review demonstrated overwhelmingly positive short-term outcomes for labral repairs; however, scattered case reports exist demonstrating debilitating outcomes in young patients, ultimately resulting in total hip arthroplasty...
February 1, 2018: Aerospace Medicine and Human Performance
Emma B Holliday, Christina Brady, William C Pipkin, Jeremy S Somerson
BACKGROUND: The observed sex gap in physician salary has been the topic of much recent debate in the United States, but it has not been well-described among orthopaedic surgeons. The objective of this study was to evaluate for sex differences in Medicare claim volume and reimbursement among orthopaedic surgeons. METHODS: The Medicare Provider Utilization and Payment Public Use File was used to compare claim volume and reimbursement between female and male orthopaedic surgeons in 2013...
February 21, 2018: Journal of Bone and Joint Surgery. American Volume
Amit Atrey, Jesse I Wolfstadt, Nasir Hussain, Amir Khoshbin, Sarah Ward, Emil H Schemitsch, James P Waddell
BACKGROUND: The optimum bearing surface for total hip arthroplasty remains debatable. We have previously published our outcome at 10 years and this represents the 15-year follow-up. METHODS: A total of 58 hips (in 57 patients with a mean age of 42 years) were randomized to receive either ceramic-on-ceramic (CoC) or ceramic-on-polyethylene (CoP) total hip arthroplasty. We prospectively followed for survivorship, functional outcomes (using the Harris Hip Score and the St Michael's Hip Score [SMH]), and radiological outcomes...
December 6, 2017: Journal of Arthroplasty
Michael E Neufeld, Anthony Albers, Nelson V Greidanus, Donald S Garbuz, Bassam A Masri
BACKGROUND: The long-term survivorship and functional outcomes of the mobile-bearing (MB) compared to the fixed-bearing (FB) unicompartmental knee arthroplasty (UKA) implant design remain a topic of debate. The aim of the current study was to compare the survivorship and functional outcomes of MB and FB UKA at a minimum 10-year follow-up. METHODS: We retrospectively reviewed 106 consecutive medial UKAs (89 patients) from our institution with a minimum 10-year follow-up...
January 11, 2018: Journal of Arthroplasty
Lasse E Rasmussen, Henriette A Holm, Per W Kristensen, Per Kjaersgaard-Andersen
BACKGROUND: Whether the arterial tourniquet in total knee arthroplasty (TKA) is a friend or a foe is still debated. Longer ischemia causes hypoxic damage; yet short duration of a tourniquet may influence outcome. Understanding the time-dependent influence of the tourniquet in TKA patients could improve the overall outcome and safety. The purpose of the study was to measure the tourniquet-induced time-dependent alterations in skeletal muscle metabolism in TKA to establish a 'safe tourniquet time...
January 26, 2018: Knee
Zhen Wang, Jia Zheng, Yongqiang Zhao, Yungai Xiang, Xiao Chen, Fei Zhao, Yi Jin
BACKGROUND: Surgical site infection is a devastating postoperative complication, and the occurrence ranges from 1% to 2% after total knee arthroplasty (TKA). The efficacy of the preoperative use of chlorhexidine for reducing infection has been debated. This meta-analysis aimed to examine the efficacy of the use of chlorhexidine to prevent surgical site infections after TKA. METHODS: In February 2017, a systematic literature review was conducted using the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and the Google database...
November 2017: Medicine (Baltimore)
Kyoung-Tak Kang, Juhyun Son, Changhyun Baek, Oh-Ryong Kwon, Yong-Gon Koh
BACKGROUND: In recent years, the popularity of unicompartmental knee arthroplasty (UKA) has increased. However, the effect of femoral component positioning in UKA continues to invite a considerable debate. The purpose of this study involved assessing the biomechanical effect of mal-alignment in femoral components in UKA under dynamic loading conditions using a computational simulation. METHODS: A validated finite element model was used to evaluate contact stresses in polyethylene (PE) inserts and lateral compartment and force on collateral ligament in the femoral component ranging from 9° of varus to 9° of valgus...
January 22, 2018: Archives of Orthopaedic and Trauma Surgery
Alberto Grassi, Riccardo Compagnoni, Paolo Ferrua, Stefano Zaffagnini, Massimo Berruto, Kristian Samuelsson, Eleonor Svantesson, Pietro Randelli
PURPOSE: The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA. METHODS: A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores...
January 15, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Mehrnoush H Yeganeh, Michael M Kheir, Alisina Shahi, Javad Parvizi
The incidence of periprosthetic joint infection (PJI) among patients with rheumatoid arthritis (RA) is 1.6× greater than in patients undergoing the same procedure for osteoarthritis. This higher risk "may" be due to the immunosuppressive therapies for RA patients including corticosteroids, such as prednisone, and disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. There is a debate about the role of DMARDs in increasing the incidence of subsequent PJI. Studies show conflicting results, with some demonstrating no significant increase in the rates of PJI and some finding otherwise...
November 23, 2017: Journal of Arthroplasty
Ewout S Veltman, Dirk Jan F Moojen, Rob Ghh Nelissen, Rudolf W Poolman
BACKGROUND: To prevent postoperative infection the use of systemic antibiotic prophylaxis is common ground. Type of antibiotic used and duration of prophylaxis are subject to debate. In case of suspected early periprosthetic infection a debridement, antibiotics and implant retention (DAIR) procedure is treatment of first choice. This study evaluated the antibiotic prophylaxis and DAIR treatment protocols nationwide as well as reporting of these DAIR procedures to the national joint registry...
2018: Journal of Bone and Joint Infection
Daniel S Hill, Matthew Freudmann, Jamie C Sergeant, Tim Board
INTRODUCTION: The aim of this survey was to explore knee surgeons' opinions and practices regarding the management of symptomatic knee osteoarthritis in obesity. METHODS: Questionnaires were sent electronically to all consultant members of the British Association for Surgery of the Knee. RESULTS: The response rate was 52%. The survey showed considerable practice variation and divided opinion on the evidence base. The majority stated that weight loss should be the first-line treatment...
December 28, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Jean-Yves Jenny
The exact indication for a unicompartmental knee arthroplasty (UKA) remains debated. Minimally invasive techniques have been developed to decrease the surgical trauma related to the prosthesis implantation, and this technique is well fitted to UKA. However, there are concerns about loss of accuracy with minimally invasive techniques. Furthermore, rapid recovery techniques have been developed in order to reduce the length of hospital stay. Again, UKA is well fitted to these new developments of postoperative care...
December 26, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Alfredo Schiavone Panni, Francesco Ascione, Marco Rossini, Adriano Braile, Katia Corona, Michele Vasso, Michael T Hirschmann
PURPOSE: The aim of this systematic review is to analyze the effect of tibial rotational alignment after total knee arthroplasty (TKA) on clinical outcomes and assess the eventual cut-off values for tibial TKA rotation leading to poor outcomes. METHODS: A detailed and systematic search from 1997 to 2017 of the Pubmed, Medline, Cochrane Reviews, and the Google Scholar databases was performed using the keyword terms "total knee arthroplasty", "total knee replacement", "tibial alignment", "tibial malalignement", "tibial rotation", "rotational error", "axis", "angle", "tibial malrotation", "clinical outcome", in several combinations...
December 15, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Benjamin P d'S Murphy, Michelle M Dowsey, Tim Spelman, Peter F M Choong
BACKGROUND: The global demand for total hip arthroplasty (THA) is increasing, underscoring its moniker as the "operation of the century." However, debate still exists as to whether the elderly who undergo the operation achieve the same outcomes as those younger. In this study, we sought to investigate the association between older age and the risks and benefits of THA. METHODS: In this study, we aimed to compare the risks and benefits of THA of those aged ≥80 years vs those <80 years...
November 13, 2017: Journal of Arthroplasty
Matilde Tschon, Maria Sartori, Deyanira Contartese, Gianluca Giavaresi, Nicolo Nicoli Aldini, Milena Fini
BACKGROUND: Periprosthetic joint infection still represents a challenging issue for the orthopedic community. In the United States approximately a million joint arthroplasties are performed each year, with infection rates ranging from 1 to 2%: revisions has significant implications in health care costs and appropriate resources management. The use of locally applied antibiotics as a prophylaxis measure or as a component of the therapeutic approach in primary or revision surgery is finalized at eliminating any microorganism and strengthening the effectiveness of systemic therapy...
November 29, 2017: Current Medicinal Chemistry
Katharine D Harper, Shidong Li, Rachel Jennings, Kamil M Amer, Christopher Haydel, Sayed Ali
INTRODUCTION: Technologic advances have reduced medical radiation exposure while maintaining image quality. The purpose of this study was to determine the effects of the presence of total hip arthroplasty implants, compared with native hips, on radiation exposure of the most radiosensitive organs when manual and automatic exposure control settings are used. METHODS: Detection probes were placed at six locations (stomach, sigmoid colon, right pelvic wall, left pelvic wall, pubic symphysis, and anterior pubic skin) in a cadaver...
January 1, 2018: Journal of the American Academy of Orthopaedic Surgeons
Alistair I W Mayne, Peter S E Davies, James M Simpson
BACKGROUND: There is significant debate as to whether routine antibiotic treatment of asymptomatic bacteriuria (ASB) in arthroplasty patients reduces the risk of subsequent PJI. No previous systematic reviews have been undertaken on this subject. The aim of this systematic review was to investigate whether antibiotic treatment of asymptomatic bacteriuria in arthroplasty patients reduces the risk of prosthetic joint infection and to investigate whether the organisms cultured in peri-operative urine samples are the same as those responsible for subsequent prosthetic joint infections...
November 21, 2017: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Eli S Kupperman, Asher I Kupperman, Scott A Mitchell
PURPOSE: Optimal treatment strategies for radial head fractures remain a subject of debate. We examined national practice patterns in the management of radial head fractures to determine rates of surgical treatment, type of surgery employed, and the incidence of reoperation. METHODS: Between 2007 and 2011, we identified patients with radial head fractures along with their associated injuries by International Classification of Diseases, Ninth Revision codes in a national database of orthopedic insurance records...
March 2018: Journal of Hand Surgery
Luigi Piero Solimeno, Gianluigi Pasta
Today, major surgical procedures can be safely performed in hemophilic patients with chronic arthropathy, using available factor concentrates. In this setting, total knee replacement is considered the "gold standard", while the use of total ankle replacement is still debated. Indeed, the unsatisfactory results obtained with the previous available design of implants did not raise enthusiasm as knee or hip replacement. Recently, the introduction of new implant designs and better reported outcomes have renewed the interest in total ankle replacement in people with hemophilia...
November 22, 2017: Journal of Clinical Medicine
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