Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.236
Filtrar
1.
J ISAKOS ; 6(6): 363-366, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34794965

RESUMO

IMPORTANCE: One of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery. OBJECTIVE: The aim of this systematic review was to determine the rate of return to sport after reverse total shoulder arthroplasty (RSA) and the subjective level of performance. EVIDENCE REVIEW: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review. A systematic electronic search was performed using the PubMed (MEDLINE), Embase and Cochrane Library databases. All the studies analysing the rates were pooled; data were extracted and statistically analysed. The eligibility criteria were studies with at least 20 adult patients recruited. All studies had to relate return to sports after RSA. FINDINGS: A total of six studies were included for a total of 457 patients. Mean age and average follow-up were, respectively, 74.7 years (range 33-88 years) and 3.6 years (range 1-9.4 years). The mean rate of return to sport ranged from 60% to 93%. The mean time for resuming sports was 5.3 months. The overall rate of return to sport after reverse shoulder arthroplasty was 79%. The mean level of sports at the time of the survey was worsened in 7.9%, improved in 39.6% and had no change in 55.2% of the cases. CONCLUSIONS AND RELEVANCE: Based on the current available data, return to sports after reverse shoulder arthroplasty is possible and highly frequent. The subjective level of practice undergoes no change or improves in most of the cases. More studies and better-designed trials are needed in order to enrich the evidence on specific sports recovery after the procedure. LEVEL OF EVIDENCE: IV.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Esportes , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia , Artroplastia do Ombro/efeitos adversos , Humanos , Pessoa de Meia-Idade , Volta ao Esporte , Articulação do Ombro/cirurgia
2.
Artigo em Inglês | MEDLINE | ID: mdl-34769775

RESUMO

BACKGROUND: Joint-preserving surgery for the forefoot has been increasingly performed for rheumatoid arthritis (RA). We compared joint-preserving surgeries with resection arthroplasty for RA in the forefoot. METHODS: Forefoot surgeries were performed on 62 toes in 42 patients with RA (men: 2; women: 40) between 2002 and 2018. Three groups were compared: PP-31 toes treated with joint-preserving surgery involving the modified Mann method for the big toe and offset osteotomy for lesser toes, PR-15 toes treated with joint-preserving surgery for the big toe and resection arthroplasty for lesser toes, and RR-16 toes treated with resection arthroplasty for all the toes. RESULTS: The PP group had significantly higher mean scores on a scale for RA in the foot and ankle at the latest follow-up than the RR group (86 vs. 75 points; p < 0.05). Hallux valgus (angle > 20°) of the big toe at the latest follow-up recurred in 10 (32%), 9 (60%), and 16 (100%) patients in the PP, PR, and RR groups, respectively. A revision surgery was performed in one patient each in the PP and PR groups. CONCLUSIONS: Joint-preserving surgery is superior to resection arthroplasty in preventing function loss and the recurrence of hallux valgus.


Assuntos
Artrite Reumatoide , Hallux Valgus , Artrite Reumatoide/cirurgia , Artroplastia , Feminino , Hallux Valgus/cirurgia , Mãos , Humanos , Masculino , Estudos Retrospectivos
3.
J Hand Surg Asian Pac Vol ; 26(4): 684-696, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34789103

RESUMO

Background: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants and arthrodesis. This systematic review appraises their outcomes. Methods: 30 studies comprising 1,324 joints (813 pyrocarbon, 511 MoP) were included. Mean patient age was 59 years (38 to 78) and mean follow-up period was 54 months (1.2 to 380). Results: There were mean improvements of 4.5 points (2 to 6.9) in pain Visual Analogue Score, 10.5° (-26 to 58) in range of motion (ROM), 3.1 kg (-4 to 7) in grip strength, 0.6 kg (-1.5 to 2) in pinch strength, and 18 points (-3 to 29) in the Disabilities of the Arm, Shoulder and Hand score, with no significant differences between implant types. ROM gains, in particular, deteriorated over time. Clinical complications were frequent (23%), and significantly more common with pyrocarbon, as were radiographic complications. However, most were mild-moderate and did not necessarily correlate with negative outcomes or dissatisfaction. Overall reoperation rate was 21%, and revision rate 11%, both more frequent with pyrocarbon. Most revisions were within 24 months, beyond which survival was maintained up to ten years. Conclusions: Unconstrained PIP joint arthroplasty is effective at improving pain scores, active ROM, grip/pinch strength, and patient reported outcome measures, particularly in patients with osteoarthritis. Results are generally maintained at least to the medium term, although gains diminish in the longer term. Complication and early revision rates are high, particularly with pyrocarbon implants. The majority of patients express positive attitudes to arthroplasty, with significant improvements in patient-reported outcome measures for both pyrocarbon and MoP implants. Patients with post-traumatic and inflammatory arthropathy are generally less satisfied. There is currently insufficient data to recommend one implant type over another, although the early-to-medium term results of MoP implants are promising. Prospective surveillance via small joint registries is recommended.


Assuntos
Artroplastia de Substituição de Dedo , Prótese Articular , Osteoartrite , Artroplastia , Articulações dos Dedos/cirurgia , Humanos , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Estudos Prospectivos , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-34769916

RESUMO

Ankle joint distraction (AJD) has been described to be a valuable joint-sparing alternative to arthrodesis or arthroplasty; however, clinical endpoints associated to this surgical intervention are lacking. The current case report describes clinical and biomechanical outcome measures of ankle joint distraction in a 14-year-old patient with severe haemophilia A. Because of persistent and incapacitating pain and the poor response to conservative and invasive treatment options, ankle joint distraction was performed in this 14-year-old patient using an external fixator encompassing two Ilizarov full rings in the tibia and a foot ring fixed to the foot by four K-wires. State-of-the-art medical imaging and non-invasive skin marker-based 3D multi-segment foot modelling were performed in a pre- and post-operative stage. From a structural viewpoint, this AJD was a success since it improved and stabilised the osteo-cartilaginous lesions of the ankle. Biomechanical outcome measures associated with the 18-month follow-up were found to be suboptimal, showing an early plantarflexion pattern at the ankle joint during midstance and a tendency towards increased power absorption at the midfoot with peak power absorption being almost two times higher when compared to boys of the same age. From a functional viewpoint, we observed a clear reduction in the patients' physical activities until one year after AJD. Despite these functional and structural improvements, recurrent painful phenomena, including the development of a complex regional pain syndrome (CRPS) and a stress fracture of the third metatarsal bone, were observed which are probably related with the development of recurrent subchondral oedema.


Assuntos
Hemofilia A , Adolescente , Articulação do Tornozelo/cirurgia , Artrodese , Artroplastia , Fixadores Externos , Humanos , Masculino , Resultado do Tratamento
5.
Arthroscopy ; 37(10): 3079-3080, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602149

RESUMO

Acromioplasty is a well-known, simple, and reproducible surgical technique that is used in isolation or in combination with other arthroscopic procedures. The clinical value of acromioplasty combined with arthroscopic rotator cuff repair has been largely investigated. Main theoretical benefits lie in the opportunity to improve the visualization, decrease abrasive wear with prominent acromial morphology, and release natural growth factors. On the other hand, acromioplasty and release of the coracoacromial ligament may weaken the insertion of the deltoid muscle, induce scar formation in the subacromial space, theoretically limiting shoulder mobility, and increase risk of anterior-superior humeral escape, especially in patients with large to massive rotator cuff tears. Clinical studies report conflicting results. My results show no differences in clinical outcomes in rotator cuff repairs with or without subacromial decompression, regardless of the acromial morphology. At the same time, I do believe that confirmatory studies are always necessary, especially if the aim is to disprove the usefulness of a common practice.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Acrômio/cirurgia , Artroplastia , Artroscopia , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia
6.
BMC Musculoskelet Disord ; 22(1): 838, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34592991

RESUMO

BACKGROUND: Although rotator cuff syndrome is common and extensively studied from the perspective of producing healed tendons, influence of gender on patient-reported outcomes is less well examined. As activity and role demands may vary widely between men and women, clarity on whether gender is an important factor in outcome would enhance patient education and expectation management. Our purpose was to determine if differences exist in patient-reported outcomes between men and women undergoing rotator cuff surgery. METHODS: One hundred forty-eight participants (76 W:72 M) aged 35-75 undergoing surgery for unilateral symptomatic rotator cuff syndrome were followed for 12 months after surgery. Demographics, surgical data, and the Western Ontario Rotator Cuff (WORC) scores were collected. Surgery was performed by two fellowship-trained shoulder surgeons at a single site. RESULTS: There were no gender-based differences in overall WORC score or subcategory scores by 12 months post-op. Pain scores were similar at all time points in men and women. Women were more likely to have dominant-arm surgery and had smaller rotator cuff tears than men. Complication rates were low, and satisfaction was high in both groups. CONCLUSION: Patient gender doesn't appear to exert an important effect on patient-reported rotator cuff outcomes in this prospective cohort. Further work examining other covariates as well as the qualitative experience of going through rotator cuff repair should provide greater insight into factors that influence patient-reported outcomes.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroplastia , Artroscopia , Feminino , Humanos , Masculino , Estudos Prospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro , Resultado do Tratamento
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1341-1351, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651491

RESUMO

Objective: To summarize the research progress of interfacial tissue engineering in rotator cuff repair. Methods: The recent literature at home and abroad concerning interfacial tissue engineering in rotator cuff repair was analysed and summarized. Results: Interfacial tissue engineering is to reconstruct complex and hierarchical interfacial tissues through a variety of methods to repair or regenerate damaged joints of different tissues. Interfacial tissue engineering in rotator cuff repair mainly includes seed cells, growth factors, biomaterials, oxygen concentration, and mechanical stimulation. Conclusion: The best strategy for rotator cuff healing and regeneration requires not only the use of biomaterials with gradient changes, but also the combination of seed cells, growth factors, and specific culture conditions (such as oxygen concentration and mechanical stimulation). However, the clinical transformation of the relevant treatment is still a very slow process.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroplastia , Humanos , Regeneração , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Engenharia Tecidual
8.
Foot (Edinb) ; 49: 101838, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34619518

RESUMO

BACKGROUND: Both arthrodesis and total arthroplasty are acceptable surgical options for end stage hallux rigidus without significant angular deformity. Total arthroplasty preserves first metatarsophalangeal joint (MTPJ) motion, which may help restore a more physiological gait pattern. RESEARCH QUESTION: Is there a difference in the findings of gait studies after 1st MTPJ total arthroplasty or arthrodesis for end-stage hallux rigidus? METHODS: PRISMA guidelines were followed to conduct a systematic review of literature for studies reporting gait analysis after the above procedures. Predetermined criteria were used to select papers and evaluated the findings of kinematic (spatial-temporal and dynamic motion), kinetic and foot pressure (pedobarographic) studies. RESULTS: 12 titles were short-listed for synthesis. There was 1 randomized controlled trial comparing the two procedures. Among the remaining cohort studies, 5 reported on total arthroplasty and 6 on arthrodesis of the 1st MTPJ. Due to significant heterogeneity, a narrative synthesis was undertaken. No studies in the arthroplasty group reported spatial-temporal or kinetic parameters. Only 2 papers, 1 in each group, recorded motion within the foot. One of them showed preserved dynamic motion at the 1st MTPJ after total arthroplasty. Pedobarographic studies had discordant findings in studies within both groups regarding restoration of weight bearing through the medial forefoot and the pulp of the great toe during gait. CONCLUSION: Currently available studies are heterogenous and report inconsistent findings, which do not convincingly answer our research question. Prospective comparative studies with a large sample size, using standardized methodology in accredited laboratories with detailed reporting of kinetic, kinematic and pedobarographic components of gait analysis are required in order to draw concrete conclusions.


Assuntos
Hallux Rigidus , Articulação Metatarsofalângica , Artrodese , Artroplastia , Hallux Rigidus/cirurgia , Humanos , Articulação Metatarsofalângica/cirurgia , Estudos Prospectivos , Resultado do Tratamento
9.
PLoS One ; 16(10): e0257497, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665802

RESUMO

BACKGROUND: In 2002 a pyrocarbon interphalangeal joint implant was granted Food and Drug Administration approval with limited evidence of effectiveness. It is important to understand device use and outcomes since this implant entered clinical practice in order to establish incremental evidence, appropriate study design and reporting. This systematic review summarised and appraised studies reporting pyrocarbon proximal interphalangeal joint arthroplasty. METHODS: Systematic review of MEDLINE, EMBASE, SCOPUS, Web of Science, BIOSIS, CINAHL and CENTRAL from inception to November 2020. All study designs reporting pyrocarbon proximal interphalangeal joint arthroplasty in humans were included. Data extracted included information about study characteristics, patient selection, regulatory (gaining research ethics approval) and governance issues (reporting of conflicting interests), operator and centre experience, technique description and outcome reporting. Descriptive and narrative summaries were reported. RESULTS: From 4316 abstracts, 210 full-text articles were screened. A total of 38 studies and 1434 (1-184) patients were included. These consisted of three case reports, 24 case series, 10 retrospective cohort studies and one randomised trial. Inclusion and exclusion criteria were stated in 25 (66%) studies. Most studies (n = 27, 71%) gained research ethics approval to be conducted. Six studies reported conflicting interests. Experience of operating surgeons was reported in nine (24%) and caseload volume in five studies. There was no consensus about the optimal surgical approach. Technical aspects of implant placement were reported frequently (n = 32) but the detail provided varied widely. Studies reported multiple, heterogenous outcomes. The most commonly reported outcome was range of motion (n = 37). CONCLUSIONS: This systematic review identified inconsistencies in how studies describing the early use and update of an innovative procedure were reported. Incremental evidence was lacking, risking the implant being adopted without robust evaluation. This review adds to evidence highlighting the need for more rigorous evaluation of how implantable medical devices are used in practice following licencing.


Assuntos
Artroplastia , Materiais Biocompatíveis/uso terapêutico , Carbono/uso terapêutico , Prótese Articular , Artroplastia/efeitos adversos , Materiais Biocompatíveis/efeitos adversos , Carbono/efeitos adversos , Estudos de Avaliação como Assunto , Humanos , Prótese Articular/efeitos adversos , Legislação de Dispositivos Médicos , Seleção de Pacientes
10.
BMC Musculoskelet Disord ; 22(1): 749, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465332

RESUMO

BACKGROUND: Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. METHODS: A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients' age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. RESULTS: Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3-6 months follow-up, 16% at 6-12 months follow-up, 21% at 12-24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). CONCLUSIONS: Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroplastia , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/epidemiologia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
11.
BMJ Case Rep ; 14(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531239

RESUMO

Ankylosis of the temporomandibular joint is a debilitating condition resulting in progressive trismus and facial disfigurement. Common trigger factors include paediatric mandibular trauma, middle ear infection or traumatic childbirth. Although diminishing in incidence among urban population, it is still prevalent in the underprivileged world. Substandard child safety norms, delayed presentation, lack of access to specialties like maxillofacial surgery in rural areas and absence of follow-up contribute to ankylosis. Afflictions in ankylosis are multipronged, involving aesthetic, functional, psychological and nutritional implications to name a few. The damage this pathology causes to the young mind and their morale is humongous. Although well documented, a complete presentation of cases with follow-up till oral and myofascial rehabilitation is seldom reported. This paper describes multidisciplinary management of a young female patient with temporomandibular joint ankylosis. Staged management commencing from interpositional arthroplasty until dental restoration with a 2-year follow-up is presented in this paper.


Assuntos
Anquilose , Transtornos da Articulação Temporomandibular , Adulto , Anquilose/cirurgia , Artroplastia , Criança , Face , Feminino , Humanos , Gravidez , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia
12.
BMC Musculoskelet Disord ; 22(1): 778, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511076

RESUMO

BACKGROUND: Postoperative delirium (PD), as an acute brain failure, is widely reported as a very common postoperative complication, and it is closely associated with increased morbidity and mortality. Recently, malnutrition is reported as one of the risk factors for PD. The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, few studies have discussed the effectiveness of PNI as a nutritional assessment in predicting PD after primary total joint arthroplasty (TJA). The aim of this study is to investigate potential risk factors including PNI for PD following primary TJA. METHODS: A retrospective analysis of 994 patients was performed to identify risk factors associated with PD after primary TJA by using univariate and multivariate analyses. A receiver operating characteristic curve and the area under the curve were applied to evaluate the significant results of the multivariate analysis and the optimal cutoff value (CV). RESULTS: Postoperatively, sixty-seven patients (67/994, 6.7 %) experienced PD. Univariate analysis demonstrated that operative time, duration of anesthesia, age, hypertension, serum albumin, and PNI differed between the PD and non-PD groups (P < 0.05). Multivariate logistic regression analysis showed that the preoperative PNI (odds ratio [OR]: 0.908; 95 % confidence interval [CI]: 0.840-0.983; CV: 47.05), age of patients (OR: 1.055; 95 % CI: 1.024-1.087; CV: 73.5 years), and hypertension (OR: 1.798; 95 % CI: 1.047-3.086), were independently associated with PD (P < 0.05). CONCLUSIONS: A low preoperative PNI associated with malnutrition was demonstrated to be an independent risk factor for PD following primary TJA. Patients with preoperative low PNI should be cautioned and provided with adequate nutritional intervention to reduce postoperative PD.


Assuntos
Delírio , Avaliação Nutricional , Idoso , Artroplastia , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/etiologia , Humanos , Prognóstico , Estudos Retrospectivos
13.
Orthopade ; 50(10): 839-842, 2021 10.
Artigo em Alemão | MEDLINE | ID: mdl-34498129
14.
Iowa Orthop J ; 41(1): 141-144, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34552416

RESUMO

Background: Smoking tobacco is a known modifiable risk factor for complications in total joint arthroplasty (TJA) patients. Patients are commonly required to quit smoking prior to TJA. After the early postoperative period, little is known about the long-term implications of this preoperative behavioral change. Our aims were to 1) identify TJA patients that had negative anabasine screen prior to elective TJA and 2) determine the long-term rates of continued smoking abstinence. Methods: At our institution, TJA patients identified as smokers undergo urine anabasine testing prior to surgery. Between 2009 - 2018 all patients that had elective primary TJA with pre-operative urine anabasine tests were queried. Patients were called post-operatively at mean 52 months (range 15 - 126 months) and surveyed regarding smoking status. Long-term smoking cessation rates were then analyzed along with relapse time frame. The use of quit aid and patient perspective on importance of quitting were also analyzed. Results: 249 smokers that had elective TJA were identified. 124 (50%) participated in the survey, and 93 quit to facilitate surgery. 21 (23%) never resumed smoking, and 32 (34%) were currently abstinent. Just over half of the patients relapsed in the three-month post-operative period (55%). There were no differences in quit aid or patient perspectives between these groups. Conclusion: With an increased focus on smoking cessation prior to elective TJA, orthopedics contributes to an important public health initiative. Although national quit rates are in the single digits, 23% of patients were able to quit permanently.Level of Evidence: IV.


Assuntos
Artroplastia , Ortopedia , Abandono do Hábito de Fumar , Humanos , Cooperação do Paciente , Período Pós-Operatório , Fumar
15.
Neurosurg Clin N Am ; 32(4): 493-504, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538475

RESUMO

Prosthesis design has an influence on the quantity and quality of postoperative motion after cervical disc arthroplasty. Prostheses with built-in resistance to angular and translational motion may have an advantage in restoring physiologic motion. The ability of a prosthesis to work with remaining bony and soft tissues to restore motion and load-sharing is a function of the kinematic degrees of freedom DOF, axis of rotation for a given motion, and device stiffness. How these characteristics allow the prosthesis to work with the patient's anatomy will determine whether the prosthesis is successful at restoring motion and mitigating adjacent-level stresses.


Assuntos
Vértebras Cervicais , Disco Intervertebral , Artroplastia , Fenômenos Biomecânicos , Vértebras Cervicais/cirurgia , Humanos , Disco Intervertebral/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular
16.
Neurosurg Clin N Am ; 32(4): 505-510, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538476

RESUMO

Intuitively, the introduction of artificial discs into spinal surgery offered the promise of reducing the incidence of adjacent segment (AS) reoperation compared with fusion. Several early clinical studies reported nonstatistically significant differences in AS disease between total disc replacement and fusion. Given the relatively low rate of AS reoperation (∼1%-2% per year) following fusion, any appropriately powered study designed to demonstrate a statistically significant difference compared with arthroplasty would require thousands of patients and/or long-term follow-up (>5 years). Therefore, these differences only become apparent with large study size or meta-analyses and longer follow-up.


Assuntos
Degeneração do Disco Intervertebral , Fusão Vertebral , Artroplastia , Vértebras Cervicais/cirurgia , Discotomia , Humanos , Degeneração do Disco Intervertebral/cirurgia , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
17.
Neurosurg Clin N Am ; 32(4): 521-526, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538478

RESUMO

There is an ongoing desire for the development of motion-preserving facet replacement devices as an alternative to rigid fixation in hopes of better preserving the natural kinematics of the lumbar spine. Theoretically, such a construct would simultaneously address pain associated with spinal instability and prevent abnormal load distribution and adjacent segment degeneration. Several such devices have been developed including the Anatomic Facet Replacement System, the Total Facet Arthroplasty System, and the Total Posterior Arthroplasty System. Of these devices, none have yet proven to be more efficacious than rigid fixation for lumbar spinal stenosis, and studies are ongoing.


Assuntos
Doenças da Coluna Vertebral , Fusão Vertebral , Estenose Espinal , Artroplastia , Fenômenos Biomecânicos , Humanos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia
18.
Neurosurg Clin N Am ; 32(4): xi-xii, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34538479
19.
J Surg Orthop Adv ; 30(3): 125-130, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34590998

RESUMO

Systems review and quality improvement (QI) is a significant need within orthopaedic surgery. The focus of this paper is to systematically review QI principles utilized in total joint arthroplasty to determine most successful QI tools. A systematic search on MEDLINE/Pubmed, Embase, Cochrane Library and other sources was conducted from September 1991 through October 2018. The three primary improved outcomes from each article were recorded along with the date, author and subspecialty. Thirty-four eligible studies related to joint arthroplasty were identified for inclusion in the systematic review. The most common outcomes that were improved in these publications were: length of stay (LOS), cost, medication management, and patient education. Lean, clinical care pathways (CCP), plan-do-check-act (PDCA), and shared decision-making improved those metrics. Four metrics were found that were consistently improved by certain quality improvement tools: LOS, cost, medication management, and patient education. Further research is warranted to continue to build a framework for quality improvement in orthopaedic surgery. (Journal of Surgical Orthopaedic Advances 30(3):125-130, 2021).


Assuntos
Artroplastia , Melhoria de Qualidade , Humanos , Tempo de Internação
20.
Neurol India ; 69(4): 1037-1039, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507439

RESUMO

Cervical disc arthroplasty (CDA) is a newer alternative to the traditional fusion, in patients with prolapsed cervical disc in the younger eligible patient aiming to provide mobility similar to the native disc and by some ways preventing the adjacent segment disease. The rising popularity of its early success has seen emergence of a number of products in the market. In a country where cost remains an important constraint for the patients, local design products are available to cater to these lesser privileged patients. The present complication is an acute dissociation of components from such a product wherein the implant was retrieved and fusion was done. The patient was subsequently discharged uneventfully.


Assuntos
Degeneração do Disco Intervertebral , Fusão Vertebral , Artroplastia/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia , Humanos , Degeneração do Disco Intervertebral/cirurgia , Próteses e Implantes , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...