Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 6 Articles
Long-term data and information indicating whether minimally invasive surgery (MIS) approaches are safe and effective with total\nhip arthroplasty (THA) are lacking. Between 2004 and 2006, 75 patients with alcohol-related osteonecrosis of the femoral head\n(ONFH) who underwent 75 THAs with the two-incision approach were studied. The medical records, radiographic parameters,\nand functional outcomes were collected prospectively. All data were compared with those for matched patients who underwent\na modified Watson-Jones (WJ) approach. THA using the two-incision approach was associated with longer operation time, more\nblood loss, more lateral femoral cutaneous nerve injury, and more periprosthetic femoral fractures (...
Introduction: The instability of the joint is classified roughly into mechanical\nand functional. It is reported that the postoperative dislocation often occurs\nby the posterior approach of the THA and may be caused by functionality instability\ndue to the injury of the periarticular soft tissue. We analyzed the joint\nposition sense of the hip according to an approach of the THA and examined\neffect to give postoperative dislocation. Materials & Methods: 92 patients\n(184 hip joints) who received THA in our hospital were selected in the study.\nCases in which position sensation measurements were insufficient were excluded.\nAs for the classification, the posterior approach (PL groups) was 39\nhips, anterolateral approach (AL groups) was 30 hips, and control group was\n37 hips. Results: There was no significant difference between the AL group\nand PL group in the absolute reproduction angle error score (ARAES). The\nrelative reproduction angle error scores (RRAES) for passive internal and external\nrotations and active internal rotation were significantly lower in the AL\nand control groups than the PL group. Discussion: This study was suggested\nthat the hip joint position sense in the AL group was better retained for the\npreservation of the soft tissue....
Background: When performing arthroscopic ankle arthrodesis for end-stage ankle arthritis, internal fixation is\nperformed using bone screws after appropriate preparation.\nHowever, optimal characteristics of bone screws have not been examined in terms of pressure force. Objective\ncomparisons of bone-screw performance may provide information on procedures for arthroscopic ankle arthrodesis.\nThe study objectives were to determine whether it was possible to measure compressive force changes using the\nnewly developed device and to infer all screw characteristics from measurement results when used in actual\nsurgeries. In addition, we performed experiments on cadavers to verify whether the experimental results could be\napplied to the joints of living subjects.\nMethods: Three types of screws (S1, S2, and S3) were inserted into the unique measurement device, and the\nchanges in pressure were measured for each 45�° turn. Changes in pressure and maximum pressure force were\nrecorded after the application of the screws. After reaching the maximum pressure in the simulated bone, further\nscrew rotations were accompanied by a gradual pressure decrease to 0 MPa. We also measured pressure changes\nin a similar manner by inserting a miniature pressure sensor into the talocrural joints of cadavers.\nResults: The mean maximum pressure �± standard deviation for S1, S2, and S3 were 0.832 �± 0.164 MPa, 0.434 �± 0.\n116 MPa, and 0.414 �± 0.127 MPa, respectively. Pressure slopes to the maximum did not significantly differ between\nthe screws in the simulated bone, and a subsequent pressure decrease to 0 MPa was significantly more rapid for S1\nthan for S2 and S3. Although pressure failure after the overtightening of screws was only observed in the simulated\nbone, patterns of pressure vs. rotation angle were similar in simulated and cadaveric bones. The pressure profile\ncharacteristics of three different screw types were determined.\nConclusions: We were able to measure the compressive force changes using the newly developed device when\nthe screws were inserted. On the basis of the measurement results, we were able to infer the characteristics of all\nscrews when used in actual surgery....
Background. Recently, intra-articular tranexamic acid (IA-TXA) application has become a popular method for perioperative blood\nloss (PBL) reduction in total knee replacement (TKR). Nevertheless, through our knowledge, no previous studies had shown the\ncorrelation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT) after IA-TXA. Materials and\nMethods. A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period\n(2013-2014). Patient�s characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss\n(THL), estimated total blood loss (ETBL), and drainage volume per kg (DV/kg). Excessive PBL was defined as PBL that exceeded\n90th percentile. Results. From multivariate analysis, low preoperative hemoglobin (Hb) level and body mass index (BMI) were the\nsignificant predictors of postoperative BT (...
Background: Quite a few randomized controlled trials (RCTs) investigating the efficacy of platelet-rich plasma (PRP)\nfor treatment of knee osteoarthritis (OA) have been recently published. Therefore, an updated systematic review\nwas performed to evaluate the temporal effect of PRP on knee pain and physical function.\nMethods: Pubmed, Embase, Cochrane library, and Scopus were searched for human RCTs comparing the efficacy\nand/or safety of PRP infiltration with other intra-articular injections. A descriptive summary and quality assessment\nwere performed for all the studies finally included for analysis. For studies reporting outcomes concerning Western\nOntario and McMaster Universities Arthritis Index (WOMAC) or adverse events, a random-effects model was used for\ndata synthesis.\nResults: Fourteen RCTs comprising 1423 participants were included. The control included saline placebo, HA, ozone,\nand corticosteroids. The follow-up ranged from 12 weeks to 12 months. Risk of bias assessment showed that 4 studies\nwere considered as moderate risk of bias and 10 as high risk of bias. Compared with control, PRP injections significantly\nreduced WOMAC pain subscores at 3, 6, and 12 months follow-up (p = 0.02, 0.004, <0.001, respectively); PRP\nsignificantly improved WOMAC physical function subscores at 3, 6, and 12 months (p = 0.002, 0.01, <0.001,\nrespectively); PRP also significantly improved total WOMAC scores at 3, 6 and 12 months (all p < 0.001);\nnonetheless, PRP did not significantly increased the risk of post-injection adverse events (RR, 1.40 [95% CI,\n0.80 to 2.45], I2 = 59%, p = 0.24).\nConclusions: Intra-articular PRP injections probably are more efficacious in the treatment of knee OA in terms of pain\nrelief and self-reported function improvement at 3, 6 and 12 months follow-up, compared with other injections, including\nsaline placebo, HA, ozone, and corticosteroids....
Background: Peripheral nerve stimulation has been used for decades to treat chronic pain but has not been used\nfor postoperative analgesia due to multiple limitations, beginning with invasive electrode placement. With the\ndevelopment of small-diameter/gauge leads enabling percutaneous insertion, ultrasound guidance for accurate\nintroduction, and stimulators small enough to be adhered to the skin, neurostimulation may now be provided in a\nsimilar manner to continuous peripheral nerve blocks. Here, we report on the use of ultrasound-guided\npercutaneous peripheral nerve stimulation to treat postoperative pain.\nMaterials and methods: Subjects within 60 days of a total knee arthroplasty with pain insufficiently treated with\noral analgesics had a 0.2-mm-diameter electrical lead (pre-loaded into a 20 gauge needle) introduced percutaneously\nusing ultrasound guidance with the tip located approximately 0.5ââ?¬â??1.0 cm from the femoral nerve (a second lead was\ninserted approximately 1.0ââ?¬â??3.0 cm from the sciatic nerve for posterior knee pain). An external stimulator delivered\ncurrent. Endpoints were assessed before and after lead insertion and the leads subsequently removed. Due to the\nsmall sample size for this pilot/feasibility study, no statistics were applied to the data.\nResults: Leads were inserted in subjects (n = 5) 8ââ?¬â??58 days postoperatively. Percutaneous peripheral nerve stimulation\ndecreased pain an average of 93% at rest (from a mean of 5.0 to 0.2 on a 0ââ?¬â??10 numeric rating scale), with 4 of 5\nsubjects experiencing complete resolution of pain. During passive and active knee motion pain decreased an average\nof 27 and 30%, respectively. Neither maximum passive nor active knee range-of-motion was consistently affected.\nConclusions: Ultrasound-guided percutaneous peripheral nerve stimulation may be a practical modality for the\ntreatment of postoperative pain following orthopedic surgical procedures, and further investigation appears warranted....
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