Assuntos
Fraturas do Fêmur , Fraturas não Consolidadas , Humanos , Transplante Ósseo/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Placas Ósseas , Consolidação da Fratura , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Artroplastia de Quadril , Prótese de Quadril , Humanos , Suécia , Reoperação , Desenho de Prótese , Falha de Prótese , Sistema de RegistrosAssuntos
Artroplastia do Joelho , Infecções , Prótese do Joelho , alfa-Defensinas , Humanos , ReimplanteRESUMO
BACKGROUND: Pain management after TKA remains challenging and the efficacy of continuously infused intraarticular anesthetics remains a controversial topic. QUESTIONS/PURPOSES: We compared the side effect profile, analgesic efficacy, and functional recovery between patients receiving a continuous intraarticular infusion of ropivacaine and patients receiving an epidural plus femoral nerve block (FNB) after TKA. METHODS: Ninety-four patients undergoing unilateral TKA were prospectively randomized to receive a spinal-epidural analgesic infusion plus a single-injection FNB or a spinal anesthetic plus a continuous postoperative intraarticular infusion of 0.2% ropivacaine. All patients were blinded to their treatment with placebo saline catheters. Blinded coinvestigators collected data concerning side effect profiles (nausea, hypotension), analgesic efficacy (VAS pain scores, narcotic usage), and functional recovery (timed up and go test, quadriceps strength, WOMAC scores, Knee Society scores, early postoperative ambulatory ability, in-hospital falls). All complications and adverse events were recorded. RESULTS: The frequency of nausea and hypertension was not different between the study groups. During the first 12 and 24 postoperative hours, the mean maximum VAS pain scores were higher in the ropivacaine group than in the epidural group (first 12 hours: 3.93 versus 1.14, respectively, p < 0.0001; 12-24 hours: 3.52 versus 1.93, respectively, p = 0.008). After 24 hours, pain scores were similar between groups. Narcotic consumption was significantly higher in the ropivacaine group on the day of surgery, but overall in-hospital narcotic usage was similar between groups. There were no clinically important differences in functional recovery between groups at any time point, but patients in the epidural group were more likely to have knee buckling (32.7% versus 6.7%, p = 0.002) and delayed ambulation (16.3% versus 0.0%, p = 0.006) than patients in the ropivacaine group, though not in-hospital falls. No infections occurred in either group, and the frequency of complications was not different between groups. CONCLUSIONS: A continuous intraarticular infusion of ropivacaine can be recommended as a safe, effective alternative to epidural analgesia plus single-injection FNB after TKA. Improved analgesic efficacy in the group that received epidural analgesia plus single-injection FNB must be weighed against the disadvantage of a higher likelihood of knee buckling and delayed ambulation with that treatment approach. LEVEL OF EVIDENCE: Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Amidas/administração & dosagem , Analgesia Epidural/métodos , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Nervo Femoral , Articulação do Joelho/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Acidentes por Quedas/prevenção & controle , Idoso , Amidas/efeitos adversos , Analgesia Epidural/efeitos adversos , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/efeitos adversos , Método Duplo-Cego , Deambulação Precoce , Feminino , Humanos , Infusões Parenterais , Articulação do Joelho/inervação , Articulação do Joelho/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Cidade de Nova Iorque , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Ropivacaina , Fatores de Tempo , Resultado do TratamentoRESUMO
The use of tapered, fluted, modular, distally fixing stems has increased in femoral revision surgery. The goal of this retrospective study was to assess mid-term to long-term outcomes of this implant. Seventy-one hips in 70 patients with a mean age of 69 years were followed for an average of 10 years. Preoperative HHS averaged 50 and improved to 87 postoperatively. Seventy-nine percent hips had Paprosky type 3A or more bone-loss. All stems osseointegrated distally (100%). Two hips subsided >5mm but achieved secondary stability. Sixty-eight percent hips had evidence of bony reconstitution and 21% demonstrated diaphyseal stress-shielding. One stem fractured near its modular junction and was revised with a mechanical failure rate of 1.4%. Distal fixation and clinical improvement were reproducibly achieved with this stem design.
Assuntos
Artroplastia de Quadril/métodos , Prótese de Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osseointegração , Medição da Dor , Complicações Pós-Operatórias , Desenho de Prótese , Falha de Prótese , Reoperação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Titânio , Resultado do TratamentoRESUMO
We prospectively measured functional performances (Western Ontario and McMaster Universities Osteoarthritis Index, Short Form-36, 2-minute walk test, and timed get-up-and-go test) of patients who underwent total hip arthroplasty (THA) and had serum vitamin D levels tested during the preoperative evaluation. Of 219 patients, 102 (46.6%) had low vitamin D levels (25-hydroxyvitamin D<30 ng/mL). Low vitamin D status did not adversely affect short-term function at 6 weeks after THA. In addition, there was no association between serum vitamin D levels and the within-patient changes of scores of each outcome measurement. Because this 6-week period is generally adequate to correct vitamin D deficiency, orthopedic surgeons can safely perform THA without delay. Nevertheless, because vitamin D deficiency impairs bone quality, patients with low vitamin D levels should be treated once identified.
Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril/cirurgia , Deficiência de Vitamina D/complicações , Humanos , Osteoartrite do Quadril/sangue , Osteoartrite do Quadril/complicações , Recuperação de Função Fisiológica , Resultado do Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/sangueAssuntos
Cardiopatias , Fraturas do Quadril , Biomarcadores , Encéfalo , Humanos , Peptídeos Natriuréticos , Fragmentos de PeptídeosRESUMO
Our study aims to identify the prevalence of low vitamin D status in patients undergoing total hip arthroplasty (THA) and to evaluate the association between serum vitamin D level and the attainment of in-hospital functional milestones. We collected data from patients who underwent THA and had preoperative serum vitamin D (serum 25-hydroxy vitamin D) levels measured. From 200 patients, 79 (39.5%) had low serum vitamin D (serum 25-hydroxy vitamin D <32 ng/mL). There were no associations between serum vitamin D level and the attainment of in-hospital functional milestones as well as length of hospital stay or perioperative complications after THA. Because low vitamin D status did not compromise the short-term functional outcomes after THA, surgery need not be delayed, but low vitamin D levels should be corrected once identified.
Assuntos
Artroplastia de Quadril , Recuperação de Função Fisiológica , Deficiência de Vitamina D/epidemiologia , Vitamina D/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
For this technology overview, the tools of evidence-based medicine were used to summarize information on the effectiveness and clinical outcomes related to the usage of bone void fillers- specifically, synthetic graft materials. Comprehensive literature searches were conducted to address five key questions, which the task force that prepared the report posed as follows. Question 1 addressed the use of synthetic bone void fillers alone. Question 2 was designed to determine whether synthetic bone void fillers could successfully serve as graft extenders and eliminate the need for iliac crest bone graft. Questions 3, 4, and 5 addressed the use of allografts as a comparison with synthetic fillers because clinical results with allografts are perceived as being much closer to autografts in these areas of the spine.
Assuntos
Substitutos Ósseos , Transplante Ósseo/tendências , Medicina Baseada em Evidências , Transplante Ósseo/métodos , Humanos , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
[This corrects the article DOI: 10.1007/s11420-019-09719-6.].