共查询到20条相似文献，搜索用时 31 毫秒
1.
Charles D. Qin Mia M. Helfrich David W. Fitz Mark A. Oyer Kevin D. Hardt David W. Manning 《The Journal of arthroplasty》2018,33(5):1477-1480
Background
The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments.Methods
Via Current Procedural Terminology codes, the National Surgical Quality Improvement Project data files were queried for all patients who underwent primary THA and conversion of previous hip surgery to THA from 2005 to 2014. To better understand the isolated effect of procedure type on adverse outcomes, primary and conversion cohorts were then propensity-score matched via logistic regression modeling. Comparisons of the study's primary outcomes were drawn between matched cohorts. Statistical significance was defined by a P-value less than or equal to .05.Results
Relative to the primary THA group, the conversion THA group had statistically greater rates of Center Medicare and Medicaid Services (CMS) complications (7.5% vs 4.5%), non-home bound discharge (19.6% vs 14.7%), and longer length of hospital stay. Conversion THA was associated with increased likelihood of CMS complications (odds ratio 1.68, confidence interval 1.39-2.02) and non-home bound discharge (odds ratio 1.41, confidence interval 1.25-1.58). No statistically significant differences in mortality and readmission were detected.Conclusion
The elevated risk for CMS-reported complications, increased length of hospital stay, and non-home bound discharge seen in our study of conversion THA indicates that it is dissimilar to elective primary THA and likely warrants consideration for modified treatment within the Comprehensive Care for Joint Replacement structure in a manner similar to THA for fracture. 相似文献2.
Benjamin P. d&#x;S. Murphy Michelle M. Dowsey Tim Spelman Peter F.M. Choong 《The Journal of arthroplasty》2018,33(4):1101-1107.e1
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. We analyzed the physical status component of the Short-Form 12 Health Survey, complications within 12 months, all-cause mortality, length of hospital stay (LOS), and discharge to rehabilitation in 2457 cases of primary THA using multivariate modeling.Results
There was no difference in improvement of those older vs the younger group in physical functioning. However, the older group had 2.87 times greater odds of experiencing a post-operative medical complication and 3.49 times the rate of all-cause mortality (P < .001). Additionally, the older group encountered an additional median 0.21-day increase in LOS and had 3.93 times greater odds of being discharged to rehabilitation rather than home (P < .001). We were unable to demonstrate any difference between groups in terms of post-operative surgical or wound-related complications.Conclusion
The elderly stand to gain equivalent benefits from THA as those younger in terms of physical functioning. However, this benefit needs to be balanced against the increased risk of post-operative medical complications, increased LOS, increased requirement for rehabilitation, and ultimately the increased risk of mortality. 相似文献3.
Fernando D. Nussenbaum David Rodriguez-Quintana Sara M. Fish David M. Green Catherine W. Cahill 《The Journal of arthroplasty》2018,33(1):10-13
Background
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures with a risk of complications. Attempting to minimize complications, our institution implemented preoperative screening criteria for patients undergoing elective total joint replacement. Our study aimed to determine if screening criteria lowered total complications and/or surgical site infections (SSI).Methods
Two groups of consecutive patients undergoing TKA and THA at a single Veterans Affairs facility were evaluated prior to and after implementation of screening criteria, 520 and 475 respectively. Screening criteria included hemoglobin A1c ≤7, hemoglobin ≥11, body mass index ≤35, and albumin ≥3.5. Groups were analyzed for demographics, preoperative comorbidities, and postoperative complications. Rates of total complications and SSI were compared. Average follow-up was at least 2 years with minimum of 1 year.Results
Demographics and comorbidities outside the screening criteria were similar. Total complication rate was reduced from 35.4% to 14.8% (P < .01) after implementation of screening criteria. For TKA, total complications were reduced from 33.1% to 15.0% (P < .01) and for THA they were reduced from 42.4% to 14.2% (P < .01). SSI rates for combined TKA and THA were reduced from 4.4% to 1.3% (P < .01). For knees, SSI was reduced from 4.6% to 1.3% (P = .01) and was statistically significant. For THA, SSI decreased from 3.8% to 1.2% (P < .05).Conclusion
Our institution saw a statistically significant decrease in both SSI and total complications following implementation of preoperative screening criteria for elective TKA and THA. 相似文献4.
Rosalind P. Candelaria Palita Hansakul Alastair M. Thompson Huong Le-Petross Vicente Valero Roland Bassett Monica L. Huang Lumarie Santiago Beatriz E. Adrada 《American journal of surgery》2018,215(4):693-698
Background
To determine the cancer yield of stereotactic biopsy of suspicious calcifications identified within 24 months after breast conservation therapy (BCT).Methods
Retrospective review of stereotactic biopsies performed during 2009–2013 for suspicious calcifications in the ipsilateral breast of patients who completed BCT.Results
94/2773 (3.4%) had stereotactic biopsies for suspicious calcifications in the ipsilateral breast; 7/94 (7.4%) had DCIS (6) or invasive (1) cancer; 5/7 occurred in the same breast quadrant as the primary. All 7 originally had negative surgical margins (≥2 mm); 6 received whole breast irradiation, and 2 received adjuvant chemotherapy + endocrine therapy. Median time to detection was 11 months (range, 6–20 months). There was a strong association between calcification morphology (particularly pleomorphic) and likelihood of malignancy (p = 0.008).Conclusions
Stereotactic biopsy of calcifications identified within 24 months post-BCT has a 7% cancer yield. Tissue biopsy should be performed rather than imaging followup alone when breast calcifications have suspicious morphology. 相似文献5.
Danielle Y. Ponzio Lazaros A. Poultsides Anthony Salvatore Yuo-yu Lee Stavros G. Memtsoudis Michael M. Alexiades 《The Journal of arthroplasty》2018,33(5):1421-1425.e1
Background
The direct anterior approach (DAA) offers the potential for less soft tissue insult, improved early recovery, and reduced dislocation rates. However, complications are associated with the DAA, particularly during the learning curve. We compare the DAA learning curve experience with the posterior approach regarding in-hospital complications and revision rate.Methods
We evaluated systemic and local in-hospital complications associated with primary unilateral cementless THAs from January 1, 2010 to December 31, 2012 in 4249 patients through a posterior approach and 289 patients through a DAA. All procedures were performed consecutively by high-volume surgeons who use a single approach in a nonselective manner. The DAA was performed by surgeon transitioning from the posterior approach, thus incorporating the learning curve. Demographics were comparable. Revision procedures were captured through a minimum 4-year follow-up. Analyses compared complication and revision rates.Results
The DAA group demonstrated shorter length of stay, procedure time, lower blood transfusion rate, and increased discharge to home rate. Local and major systemic in-hospital complications were rare and comparable between groups. The minor systemic complication rate was significantly greater for the posterior group (10.9% posterior vs 6.2% DAA, P < .05). Revision rate was significantly greater for the posterior group (2.7% posterior vs 0.7% DAA, P < .032). The incidence of revision for dislocation was 1.5% for the posterior approach vs 0.4% for the DAA.Conclusion
There was an increased rate of in-hospital minor systemic complications and overall revision, predominantly due to instability, after THA by the posterior approach, in comparison with the DAA. 相似文献6.
Krishna R. Cidambi Steven L. Barnett Paige R. Mallette Jay J. Patel Nader A. Nassif Robert S. Gorab 《The Journal of arthroplasty》2018,33(3):800-804
Background
An increased rate of complications related to femoral component failure has been described with less invasive total hip arthroplasty (THA). This study evaluated the incidence of femoral complications associated with the direct anterior approach for THA.Methods
Retrospective review was performed of the initial 1120 consecutive patients who underwent direct anterior THA by 2 surgeons.Results
A total of 899 patients (80.3%) had a 2-year follow-up (range, 2-8 years). Complications within 90 days occurred in 20 patients (1.8%): 10 calcar fractures, 1 greater trochanter fracture, 1 canal perforation, 3 hematomas, 2 dislocations, 2 superficial, and 1 deep infection. Nine patients (1%) underwent revision: 5 for aseptic femoral loosening (0.55%), 1 for periprosthetic joint infection, 1 for dislocation, 1 for hip flexor irritation, and 1 for a damaged polyethylene liner.Of the 5 patients with aseptic femoral loosening, 3 had a short, mediolateral tapered stem, 1 cemented stem, and 1 S-ROM stem placed to bypass a canal perforation. There were no revisions for aseptic loosening in the collared, fully hydroxyapatite (HA)-coated compaction broached or triple tapered proximal fit and fill stem designs (70.6% of all stems). Revision rate for femoral loosening was significantly higher for tapered wedge over HA-coated, compaction broached stems (P < .005).Conclusion
Pain and function improved predictably with a 0.55% rate of femoral loosening at 2-year follow-up. Among collared, fully HA-coated and triple taper fit and fill femoral stems, there were no instances of revision for aseptic loosening vs 3 in the short stem, collarless mediolateral tapered group. 相似文献7.
Ben Molenaers Ronald Driesen Guy Molenaers Kristoff Corten 《The Journal of arthroplasty》2017,32(5):1553-1559
Background
The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as acetabular deformities or severe contractures.Methods
We retrospectively evaluated the results and complications of 29 patients with 37 complex primary THA in which an extensile approach was used. The extensile approach is described. Functional scores were collected in case the patient was ambulatory independently (n = 17).Results
The average age was 35 years (range 15-85) with a mean follow-up of 39 months (range 12-60). There were 3 (8%) intra-operative and 4 (11%) early post-operative complications (<3 months), of which 3 (8%) were anterior dislocations. Late complications (>3 months) consisted of a fibrous ingrown stem, a socket loosening following a pelvic fracture, and a late hematogenous infection (8%). Seventy-one percent of the complications occurred in the first 18 cases (49%) indicating a learning curve. The mean post-operative Harris Hip Score was 79 (range 56-97).Conclusion
Complex THA can be safely conducted through the extensile anterior approach on a regular operating room table with the use of conventional implants, even in cases with a high risk of dislocation. 相似文献8.
Young-Min Kwon Tsung-Yuan Tsai William A. Leone Ming Han Lincoln Liow 《The Journal of arthroplasty》2017,32(3):996-1000
Background
Currently, no serum metal ion threshold exists to identify adverse tissue reactions in total hip arthroplasty (THA) patients with taper corrosion. Our study aims to investigate the sensitivity and specificity of serum metal ions in detecting taper corrosion related pseudotumors in patients with dual taper modular THA.Methods
A total of 148 patients with dual taper modular THA were investigated: (1) 90 patients with pseudotumors detected with metal artifact reduction sequence-magnetic resonance imaging (MARS-MRI) and (2) 58 patients without pseudotumors on MARS-MRI. Receiver operating characteristic curves were constructed to determine the sensitivity and specificity using different metal ion thresholds. The severity of intraoperative tissue damage was correlated with preoperative metal ion levels.Results
Pseudotumor was associated with higher cobalt (5.0 μg/L vs 3.7 μg/L, P < .01) and Co/Cr ratio (6.0 vs 3.7, P < .01). The sensitivity and specificity for cobalt level of 2.8 μg/L and Co/Cr ratio of 3.8 in detecting taper corrosion–related pseudotumors on MARS-MRI was 88% and 32% and 70% and 50%, respectively. Higher intraoperative tissue damage grades demonstrated significantly higher Co/Cr ratios (8.6 vs 3.4, P = .03).Conclusion
Although metal ion levels alone should not be relied on as the sole parameter to determine revision surgery, cobalt level >2.8 μg/L and the Co/Cr ratio >3.8 are useful clinical diagnostic adjuncts in the systematic clinical evaluation for taper corrosion–related adverse tissue reactions in patients with dual modular taper THA. 相似文献9.
Kenichi Oe Hirokazu Iida Fumito Kobayashi Narumi Ueda Tomohisa Nakamura Naofumi Okamoto Takanori Saito 《Journal of orthopaedic science》2018,23(6):992-999
Background
The optimum approach in total hip arthroplasty (THA) should reduce the risk of postoperative dislocation or limping, be applicable in every case, and be reusable in the future. The purpose of this study was to introduce our transgluteal approach for THA and to evaluate the type and frequency of complications around the greater trochanter.Methods
This study retrospectively evaluated 892 THA cases between January 2010 and March 2015 performed using our transgluteal approach that osteotomized only the lateral anteroinferior greater trochanter. The trochanteric fragment was reattached using one of three different protocols: Group A, three non-absorbable polyester sutures; Group B, two non-absorbable polyester sutures and one ultra-high molecular weight polyethylene (UHMWPE) fiber cable; or Group C, two UHMWPE fiber cables. Postoperative complications were assessed and recorded, and univariate logistic regression analyses were performed to determine whether risk factors and radiological complications around the greater trochanter were correlated.Results
None of the hips required revision for infection, dislocation, or limping. The rate of radiological complications around the greater trochanter at 1 year was 19.2% in Group A, 16.3% in Group B, and 7.9% in Group C (p < 0.001). Risk factors for radiological complications included the patient's disease or the surgeon's experience in Group A and the patient's age or the surgeon's experience in Group C. In the relationship between postoperative pain around the greater trochanter and radiological complications, there were no significant differences in all groups; no group interaction was observed (p= 0.3875).Conclusion
The UHMWPE fiber cable was effective to reduce complications of the reattached osteotomized greater trochanter in THA. 相似文献10.
Jaiben George Evan M. Miller Carlos A. Higuera Thomas E. Kuivila Michael A. Mont Ryan C. Goodwin 《The Journal of arthroplasty》2018,33(4):1108-1112
Background
As the indications for total hip arthroplasty (THA) have expanded, this procedure is being increasingly performed in young patients. Oftentimes, this population has undergone one or more salvage procedures in an attempt to delay or forestall a THA. However, it is unclear whether patients with prior salvage procedure have higher risk of adverse events.Methods
From 2004 to 2014, 215 THAs performed in patients less than 30 years at a single institution were identified. These patients were screened to identify 37 THAs in which one or more salvage procedures were performed prior to the THA (salvage group). The prior salvage procedures were open in 30 (pelvic osteotomy = 5, femoral osteotomy = 15, combined osteotomy = 2, core decompression = 7, bone graft = 1) and arthroscopic in 7. Medical and surgical complications within 90 days and overall survivorship at a minimum follow-up of 2 years were recorded. Nonparametric tests and Kaplan-Meier survival curves were used to compare the groups.Results
Salvage group had a higher rate of wound complications (P = .037), superficial infections (P = .005), and reoperations (P = .015). The 5-year survivorships in the salvage and nonsalvage groups were 97.1% and 96.7%, respectively (P = .787).Conclusion
Patients less than 30 years who undergo THA after a previous salvage procedure have a higher risk of wound complications, superficial infections, and reoperations, but similar survivorship, compared to those who did not have any prior salvage procedures. This information is helpful in counseling young patients while offering various surgical options for the management of various hip pathologies. 相似文献11.
Nicholas A. Bedard Andrew J. Pugely Michael A. McHugh Nathan R. Lux Kevin J. Bozic John J. Callaghan 《The Journal of arthroplasty》2018,33(1):41-45.e3
Background
Use of large databases for orthopedic research has become extremely popular in recent years. Each database varies in the methods used to capture data and the population it represents. The purpose of this study was to evaluate how these databases differed in reported demographics, comorbidities, and postoperative complications for primary total hip arthroplasty (THA) patients.Methods
Primary THA patients were identified within National Surgical Quality Improvement Programs (NSQIP), Nationwide Inpatient Sample (NIS), Medicare Standard Analytic Files (MED), and Humana administrative claims database (HAC). NSQIP definitions for comorbidities and complications were matched to corresponding International Classification of Diseases, 9th Revision/Current Procedural Terminology codes to query the other databases. Demographics, comorbidities, and postoperative complications were compared.Results
The number of patients from each database was 22,644 in HAC, 371,715 in MED, 188,779 in NIS, and 27,818 in NSQIP. Age and gender distribution were clinically similar. Overall, there was variation in prevalence of comorbidities and rates of postoperative complications between databases. As an example, NSQIP had more than twice the obesity than NIS. HAC and MED had more than 2 times the diabetics than NSQIP. Rates of deep infection and stroke 30 days after THA had more than 2-fold difference between all databases.Conclusion
Among databases commonly used in orthopedic research, there is considerable variation in complication rates following THA depending upon the database used for analysis. It is important to consider these differences when critically evaluating database research. Additionally, with the advent of bundled payments, these differences must be considered in risk adjustment models. 相似文献12.
Christopher Del Balso Matthew G. Teeter Sok C. Tan Brent A. Lanting James L. Howard 《The Journal of arthroplasty》2018,33(1):268-272
Background
Trunnionosis at the modular head-neck taper interface in metal-on-polyethylene total hip arthroplasty (MoP THA) has been shown to occur, and represents a potential mode of MoP THA failure. The purpose of the present investigation is to elucidate differences in fretting and corrosion at the head-neck taper interface of prostheses retrieved from bipolar hemiarthroplasty (BH) and MoP THA.Methods
A retrieval analysis of BH and MoP THA prostheses featuring a single taper design from a single manufacturer and in vivo for a minimum 2 years was performed. Fifteen femoral heads of 28-mm diameter and corresponding femoral stems retrieved from BH were compared with MoP THA implants matched based on time in vivo and head length (28 mm, ?3 mm to 28 mm, +8 mm). Fretting and corrosion damage scoring was completed under stereomicroscopic visualization.Results
Femoral head bore tapers retrieved from BH exhibited decreased overall fretting (P = .02), when compared to those retrieved from MoP THA. Total corrosion scores for all retrieved implants were positively correlated with implantation time (ρ = 0.54, P < .02).Conclusion
Femoral heads retrieved from BH exhibit decreased fretting damage compared to those retrieved from MoP THA. The added articulation in BH implants may decrease torque produced at the head-neck taper junction, thereby decreasing fretting. Increased fretting damage in implants from MoP THA is not associated with increased corrosion in 28-mm heads of this taper design. The longer a BH or MoP THA prosthesis is implanted, the greater the risk of damage due to corrosion. 相似文献13.
Daisuke Hara Satoshi Hamai Keisuke Komiyama Goro Motomura Kyohei Shiomoto Yasuharu Nakashima 《The Journal of arthroplasty》2018,33(2):423-430
Background
No studies have compared sports participation between total hip arthroplasty (THA) and periacetabular osteotomy (PAO) in matched Asian cohorts. We investigated sports participation and activity levels in Asian THA cohort, and compared them between THA and PAO cohorts.Methods
Multivariate analyses were applied to determine which factors were associated with postoperative sports participation and University of California-Los Angeles (UCLA) activity score in (1) 524 THA patients and (2) 487 acetabular dysplasia patients (295 THA patients and 192 PAO patients). In addition, postoperative sports participation and UCLA score were compared between 62 THA and 62 PAO patients after adjusting for baseline characteristics with propensity score matching.Results
Sports participation and UCLA score significantly increased after THA (P < .001 in both analyses). Preoperative sports participation was the factor most associated with both postoperative sports participation and UCLA score in both 524 THA patients and 487 acetabular dysplasia patients (P < .001 in all analyses). Multivariate analysis in 487 acetabular dysplasia patients demonstrated that THA, compared with PAO, was negatively associated with postoperative sports participation (P < .001), but not postoperative UCLA score (P = .22). THA patients showed significantly lower rate of postoperative sports participation (32.3% and 51.6%, respectively, P = .046), but not postoperative UCLA score (5.0 ± 1.6 and 5.2 ± 1.9, respectively, P = .47) compared with matched PAO patients.Conclusion
THA significantly increased both sports participation and activity levels. Both multivariate and propensity score-matched analyses showed that postoperative activity levels were comparable between THA and PAO cohorts. 相似文献14.
Rahul Goel Patrick Buckley Emily Sterbis Javad Parvizi 《The Journal of arthroplasty》2018,33(11):3547-3550
Background
Two-stage exchange arthroplasty is the preferred treatment for chronic periprosthetic joint infection following total hip arthroplasty (THA). These patients are at high risk of substantial blood loss and perioperative blood transfusion. Our study aimed at determining risk factors for blood transfusion during a 2-stage exchange for infected THA.Methods
Medical records of 297 patients with infected THA who underwent 2-stage exchange arthroplasty from 1997 to 2016 were reviewed. Blood loss was calculated using a validated formula. Transfusion data, clinical information, and operative data were gathered to determine predictors of blood loss and risk factors for perioperative allogeneic blood transfusion.Results
Calculated blood loss was significantly higher during reimplantation than resection arthroplasty (5156.0 ± 3402 mL vs 3706.9 ± 2148 mL; P < .0001). Blood transfusion was needed in 81% after resection and 81.1% after reimplantation. Allogeneic blood transfusion averaged 3.6 ± 1.8 units for stage 1 and 4.2 ± 2.9 units for stage 2 (P = .0066). Patient characteristics that increased the likelihood for perioperative blood transfusions were increasing preoperative international normalized ratio, type 2 diabetes, current smoking, age, and transfusion requirement in the first stage. Tranexamic acid usage was associated with decreased blood loss.Conclusion
Patients with periprosthetic joint infection following THA have significant blood loss during both stages of exchange arthroplasty, especially reimplantation. Hematological optimization should be considered in all patients requiring a transfusion after the first stage, as these patients are at greater risk of requiring transfusion after the second stage. The use of tranexamic acid dramatically decreases the risk of requiring a transfusion in both stages and should be more ubiquitously incorporated into blood management protocols. 相似文献15.
Chirag K. Shah Aakash Keswani Ben D. Boodaie Dong-Han Yao Karl M. Koenig Calin S. Moucha 《The Journal of arthroplasty》2017,32(1):246-251
Background
This study aimed at assessing short-term risk of serious cardiac events after elective total joint arthroplasty (TJA) as compared to a less-invasive procedure, knee arthroscopy (KA).Methods
Patients who underwent elective primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or KA from 2011 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. A 1:1 propensity matching was used to generate 2 control cohorts of KA patients with similar characteristics. Bivariate and multivariate analyses were assessed using perioperative variables.Results
A total of 24,203 THA, 21,740 TKA, and 45,943 KA patients were included. Bivariate analysis revealed significantly higher rates of serious 30-day cardiac events (myocardial infarction or cardiac arrest) among THA (0.15% vs 0.05%, P < .001) and TKA patients (0.14% vs 0.05%, P < .03) vs KA controls. In multivariate analysis controlling for patient characteristics and comorbidities, THA and TKA were associated with a 2.61 and 1.98 times odds of serious 30-day cardiac events as compared to controls (P ≤ .03 for both). Additional independent predictors of serious 30-day cardiac events included age, smoking, cardiac disease, and American Society of Anesthesiologists class 3/4. In the THA and TKA cohorts, serious cardiac events occurred within the first 3 days postoperation compared to 4 days in controls.Conclusion
After controlling for patient characteristics and comorbidities, TJA increased the short-term risk of serious cardiac event compared to a less-invasive procedure. This information better quantifies the risk differential for patients considering surgery as they engage in shared decision making with their providers. In addition, our data may have an impact on perioperative management of antithrombotic medications used in patients with cardiac disease. The median time in days to serious cardiac event was 2 in THA and 3 in TKA vs 4 in KA, which may have implications in postoperative monitoring of patients after surgery. 相似文献16.
Yiting Lei Qiang Huang Bin Xu Shaoyun Zhang Guorui Cao Fuxing Pei 《The Journal of arthroplasty》2018,33(5):1426-1431
Background
The recommended dose regimen of dexamethasone in total hip arthroplasty (THA) has not been determined. This study was performed to assess the effects of multiple low-dose dexamethasone on clinical outcomes after THA.Methods
Two hundred ten patients undergoing THA received 3 doses of normal saline (Group A), 2 doses of intravenous dexamethasone and 1 dose of normal saline (Group B), or 3 doses of intravenous dexamethasone (Group C). The primary outcome was the visual analog scale (VAS) score for pain and nausea. The incidence of postoperative nausea and vomiting, use of analgesic and antiemetic rescue, C-reactive protein (CRP) level, range of motion, length of stay (LOS), and complications were also compared.Results
The VAS score (dynamic pain and nausea) on postoperative day 1 was significantly lower in Groups C and B than Group A. On postoperative day 2, the VAS score (dynamic pain and nausea) was lower in Group C than Groups A and B. In Group C, patients had a lower incidence of postoperative nausea and vomiting and reduced use of analgesic and antiemetic rescue. The CRP level was lower in Group B than Group A. Group C had the lowest CRP level among all 3 groups. LOS was shorter in Group B than Group A, while Group C had an even shorter LOS than Group B. Range of motion was greater in Group C. No complications occurred in any group.Conclusion
The 3-dose dexamethasone regimen can further relieve postoperative pain, ameliorate postoperative nausea, provide additional inflammatory control, enhance mobility, and shorten LOS following THA. 相似文献17.
Matthew P. Abdel Brian P. Chalmers Robert T. Trousdale Arlen D. Hanssen Mark W. Pagnano 《The Journal of arthroplasty》2017,32(9):2744-2747
Background
A previous randomized clinical trial at our institution demonstrated slower recovery of 35 2-incision total hip arthroplasties (THAs) when compared with 36 mini-posterior THAs at 2 years. The primary aim of the present study was to report concise 10-year follow-up results.Methods
We retrospectively reviewed the 71 patients in the previous randomized clinical trial, comparing clinical outcomes, revisions, reoperations, and implant survivorship between the 2-incision and the mini-posterior THAs.Results
At the most recent follow-up, the mean Harris hip score was 85 in the 2-incision group and 87 in the mini-posterior group (P = .4). There were 4 revisions and 2 reoperations (16%) in the 2-incision group vs 1 revision and 3 reoperations (11%) in the mini-posterior group (P = .5). Ten-year survivorship free of aseptic revision or reoperation was 77% in the 2-incision group vs 90% in the mini-posterior group (P = .15).Conclusion
There were no improvements in early or midterm clinical outcomes with the 2-incision technique. However, there was a clinical trend toward a higher rate of aseptic revisions in the 2-incision THA group. 相似文献18.
Takeshi Utsunomiya Goro Motomura Satoshi Ikemura Satoshi Hamai Jun-ichi Fukushi Yasuharu Nakashima 《The Journal of arthroplasty》2017,32(9):2768-2773
Background
Since Sugioka transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiologic outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH.Methods
Twenty-four hips in 20 patients who underwent cementless THA after ARO (postosteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (primary group). In the postosteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score. A radiographic examination was performed at 3 months after THA and at the latest follow-up.Results
The Harris Hip Score at the latest follow-up in the postosteotomy group was equivalent to that in the primary group, but longer operation time and greater intraoperative blood loss were observed in the postosteotomy group. There were no significant differences in postoperative complications, including dislocation (2 hips in each group). The leg lengthening in the postosteotomy group tended to be longer. No hips showed implant malpositioning, loosening, or required any revision surgery.Conclusion
The clinicoradiologic outcomes of THA after ARO are considered to be comparable with those of THA without any antecedent surgery for ONFH. 相似文献19.
Stephanie A. Valente Yitian Liu Siddhi Upadhyaya Chao Tu Debra A. Pratt 《American journal of surgery》2019,217(3):514-518
Introduction
The aim of this study was to determine whether complications following mastectomy with immediate breast reconstruction (IBR) were associated with breast cancer recurrence.Methods
A retrospective review was performed of women diagnosed with stage I-III breast cancer who underwent mastectomy with IBR between 2005 and 2010. Patient demographics, tumor data, surgical wound complications, treatment details and timing were recorded and analyzed.Results
We identified 458 women with a median follow up time of 7.6 years. A total of 22% of patients experienced IBR complications. There was a delay in initiation of adjuvant therapy in patients who had a complication (52 vs 41 days, p?<?0.001). There was no significant difference in recurrences between groups with and without complications (p?=?0.65).Conclusions
In breast cancer patients who undergo mastectomy with IBR, wound complications delayed initiation of adjuvant systemic therapy, but were not associated with an increased risk of cancer recurrence. 相似文献20.
J.R. Naranjo-Izurieta Z. Ruiz de Azúa-López J. Lameirao L. Martín-Villén A. Roldán-Reina M. Porras-López A. Rodríguez-Rodríguez J.J. Egea-Guerrero 《Transplantation proceedings》2018,50(2):644-645