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1.
Ahmed El-Bakoury Hazem Hosny Mark Williams Jonathan Keenan Rathan Yarlagadda 《The Journal of arthroplasty》2017,32(2):541-545
Background
Periprosthetic fracture following total hip arthroplasty is a significant problem faced by hip surgeons, and its management in elderly patients remains a considerable challenge.Methods
We retrospectively reviewed 28 Vancouver B2 and B3 periprosthetic femoral fractures (PFF) treated with revision of the femoral stems by distally locked, hydroxyapatite-coated uncemented stems (Cannulok). Patients were aged 75 years or older at the time of surgery.Results
The mean follow-up was 44.6 months (range, 24-102). The mean postoperative Oxford hip score was 30.1 (range, 10-46). The rate of fracture union was 95.8%, and the survivorship of the stem was 100% at the end of follow-up.Conclusion
The management of PFF in elderly is associated with increased postoperative morbidity and mortality. The use of a distally locked, hydroxyapatite-coated femoral stem is a valid option for the treatment of PFF to achieve fracture union with a low rate of revision. 相似文献2.
Massimo Mariconda Giovangiuseppe Costa Mario Misasi Pasquale Recano Giovanni Balato Maria Rizzo 《The Journal of arthroplasty》2017,32(2):447-452
Background
Total hip arthroplasty (THA) has not only been associated with best functional outcomes but also with higher dislocation risk when compared with bipolar hemiarthroplasty (HA). The functionality and activities of daily living (ADL) of patients treated with THA or HA for intracapsular hip fracture (IHF) have been scarcely investigated in comparison with the preoperative status.Methods
Two comparable groups of 60 patients with an IHF who had undergone either THA or bipolar HA were created matching several preoperative characteristics. Matched variables included age, gender, body mass index, surgical delay, American Society of Anesthesiologists class, comorbidity, cognitive status, educational status, prefracture functional status, and radiographic fracture classification. Patients were prospectively followed up for 1 year using telephone interviews.Results
The ambulatory ability (5-item scale) and ADL Index significantly decreased in both the groups in comparison with the prefracture status at the 4-month and 1-year follow-up. The need for walking aids (5-item scale) at 4 months was significantly higher among patients who had undergone HA. Lower scores on the ADL Index were recorded among patients with HA in comparison with those with THA at 4 months and 1 year. No significant differences in ambulatory ability, complication rate, and mortality were detected between the 2 groups although HA and THA were associated with a tendency to a higher prevalence of general and local complications, respectively.Conclusion
THA provides better short-term results in terms of ADLs and allows early discontinuation in the use of walking aids as compared with bipolar HA in elderly cognitively intact patients with IHF. 相似文献3.
Toshiyuki Miyawaki Keigo Kumamoto Kaori Shimoda Fusae Tozato Tsutomu Iwaya 《Journal of orthopaedic science》2017,22(2):339-344
Background
Locomotive disorders are one of the main causative pathologies for the condition requiring assistance on activities of daily living (ADL). Although psychological concerns such as feeling of depression and anxiety are prevalent in elderly people, the causal relation among motor function, ADL disability, and psychological concerns is controversial.Purpose
Purpose of this study was to investigate causal relationship among motor function, ADL disability, and psychological concerns in elderly people with locomotive disorders.Methods
The data for this study were from a community-dwelling sample of 314 elderly persons with locomotive disorders aged 65 and older who visited orthopedic clinics and/or affiliated institutions. Motor function was assessed by one-leg standing time with eyes open, leg extension power and grip power. We assessed ADL disability using the 25-question Geriatric Locomotive Function Scale (GLFS-25), and psychological concerns by three self-reported questions. We constructed two models and tested fitness of the models to the data using a structural equation modeling (SEM). Model 1: motor function affects ADL disability and ADL disability affects psychological concerns, Model 2: motor function affects psychological concerns and psychological concerns affects ADL disability.Results
The fit indices were chi-square = 23.152 (p = 0.081), RMSEA = 0.042, GFI = 0.981, AGFI = 0.955, CFI = 0.987 for Model 1, and chi-square = 84.583 (p < 0.001), RMSEA = 0.119, GFI = 0.935, AGFI = 0.854, CFI = 0.892 for Model 2. These fit indices indicated a good fit of the model 1 and inadequate fit of model 2 to the data.Conclusion
Decline of motor function contributed toward psychological concerns via ADL disability in elderly people with locomotive disorders. 相似文献4.
Vahit Emre Ozden Goksel Dikmen Burak Beksac Ismail Remzi Tozun 《Journal of orthopaedic science》2017,22(3):517-523
Background
To evaluate the long-term clinical and radiological outcomes of cementless total hip arthroplasty (THA) in high riding hip dislocated patients with previous proximal femoral osteotomy.Methods
Twenty-one consecutive patients with a mean age forty-two years were treated with cementless THA Step-cut subtrochanteric femoral osteotomy was performed in all twenty-eight hips. Metal on polyethylene (MoP) and ceramic on ceramic (CoC) bearings were used in two different consecutive time periods. The mean follow-up time was twelve years. Harris hip score, limb length discrepancy, complications, union status of the osteotomy, survivorship of constructs were the criteria for evaluation.Results
The mean Harris hip score improved from 39.5 to 88.7 points. The mean limb length discrepancy in unilateral cases decreased from 54.5 mm to 12.3 mm. The mean amount of femoral shortening was 37 mm. The mean union time was 3.5 months and there were no delayed union and non-union. There were three cup and two femoral revisions due to osteolysis in patients who had MoP. There was only one femoral revision in patients who had CoC. The Kaplan Meier survivorship with an end point of any revision of the stem and the acetabular component was 94% (95% CI, 75%–98%) and 92% (95% CI, 74%–99%) at ten years respectively.Conclusions
Total hip arthroplasty with subtrochanteric step-cut femoral shortening is a successful technique to improve the hip functions and reconstruct limb length discrepancy in young patients with proximal femoral deformities. 相似文献5.
Purpose
To identify factors influencing overall radiologic changes in the distal radioulnar joint after ulnar shortening osteotomy (USO) in patients with idiopathic ulnar impaction syndrome.Materials and methods
A total of 310 patients who had undergone USO between May 2007 and December 2013 were included in this retrospective case–control study. The patients were classified into two groups (with or without radiologic findings of new arthritic changes), after which the following factors were analyzed: 1) demographic factors; 2) radiologic aspects, including ulnar variance (UV), morphological DRUJ type (classified according to Tolat et al.), and union period after USO; and 3) operative aspects, including the triangular fibrocartilage complex degeneration type, use of a parallel double-blade saw, type of plate used for fixation, and plate position on the volar or dorsal ulnar surface.Results
Group 1 (no arthritic changes) consisted of 243 patients, whereas Group 2 (arthritic changes) consisted of 67 patients. Univariate and multivariate analyses showed that the presence of lunate cystic changes, amount of shortening, and the union period were significantly associated with newly developed arthritic changes in the distal radioulnar joint (DRUJ) after USO. The morphological DRUJ type was not a significant factor. Arthritic changes were significantly more prevalent in patients with a shortening amount >4.5 mm and a union period <3.25 months.Conclusions
Radiologic arthritic changes after USO, were associated with the presence of cystic changes in the lunate, a shortening amount (>4.5 mm), and early bony union (<3.25 months).Type of study/level of evidence
Therapeutic level III. 相似文献6.
Background
De novo gastric cancer is a rare complication of liver transplantation.Methods
Surgical treatments of 16 cases with different outcomes were reported in the English literature.Results
De novo gastric cancer (stage II) was diagnosed as the result of epi-gastric discomfort in a recipient 10 years after liver transplantation. The patient received chemotherapy alone and remained well for 26 months.Conclusions
De novo gastric cancer of liver transplantation recipients is a severe complication; early detection and relevant intervention will benefit these recipients. 相似文献7.
Tsuyoshi Tajika Atsushi Yamamoto Noboru Oya Chisa Okura Satoshi Shinagawa Takanori Kitagawa Hiroki Kobayashi Haku Iizuka Kenji Takagishi 《Journal of orthopaedic science》2017,22(1):144-148
Objective
This study investigated the relation between self-assessment of upper extremity function and locomotive syndrome in a general population.Methods
Using the 25-question Geriatric Locomotive Function (GLFS-25) test, 320 Japanese people (115 men, 205 women, mean age 67.6 years, 40–92 years) were evaluated for locomotive dysfunction. All had completed a self-administered questionnaire including items for sex, weight, height, dominant hand, and the degree of frequency of hand in ADL. We measured the bilateral hand grip and key pinch strength as indicators of hand muscle function. Study participants were assessed for upper extremity dysfunction using Hand 10, a self-administered questionnaire for upper extremity disorders, and using the Japanese Society for Surgery of the Hand Version of Disability of the Arm, Shoulder, and Hand. Statistical analyses were conducted to clarify the association between upper extremity dysfunction and screening results for locomotive dysfunction.Results
Participants reporting any upper extremity dysfunction were 137 (47 men, 90 women) out of 320 participants. The GLFS25 score was found to have significant positive correlation with age and Hand 10 scores. Significant negative correlation was found with the GLFS25 score and dominant grip strength, non-dominant grip strength, dominant key pinch strength, and non-dominant key pinch strength. Univariate analysis revealed a significant association with age, sex, bilateral hand grip, and key pinch, and with the Hand 10 score and Locomotive syndrome. Logistic regression analysis applied after adjustment for age, sex, height, and weight revealed a significant association between Locomotive syndrome and each of non-dominant hand grip (OR 0.73, 95%CI 0.61–0.87) and the Hand 10 questionnaire score (OR 1.10, 95%CI 1.06–1.14).Conclusion
Locomotive syndrome is associated with the decline of self-assessed and observed upper extremity function.Study design
Cross-sectional study. 相似文献8.
Jie J. Yao Hilal Maradit Kremers Cathy D. Schleck Dirk R. Larson Jasvinder A. Singh Daniel J. Berry David G. Lewallen 《The Journal of arthroplasty》2017,32(11):3319-3321
Background
Patient-reported outcomes are increasingly used to capture the patients' perspective in total hip arthroplasty (THA). They can potentially be used to streamline post-THA follow-up to high-risk patients. We aimed to determine whether the long-term revision risk in THA relates to patient-reported measures at 2 and 5 years.Methods
In a single-institution cohort of primary THA procedures, we examined the association between 2-year and 5-year pain and Mayo Hip Scores and the risk of revision.Results
The absolute scores at 2 and 5 years were both significantly associated with the risk of revisions. Every 10-unit decline in the 2-year Mayo Hip Score <60 was associated with a significant 50% increase in the risk of revision (hazard ratio, 1.5 per 10 units; 95% confidence interval, 1.3-1.8). Similarly, every 10-unit decline in the 5-year Mayo Hip Score <60 was associated with almost doubling of the risk of revision (hazard ratio, 1.9 per 10 units; 95% confidence interval, 1.7-2.1).Conclusion
We conclude that patient-reported outcomes in THA have prognostic importance and can be taken into account when planning frequency of aftercare. This will improve the efficiency of follow-up in large registry-based follow-up efforts. 相似文献9.
Andrew D. Stewart Hesham Abdelbary Paul E. Beaulé 《The Journal of arthroplasty》2017,32(9):2864-2868.e1
Background
Greater trochanteric fracture/nonunion can be a devastating complication with significant functional impact after total hip arthroplasty, and their fixation remains a challenge because of the significant forces being transmitted as well as the poor bone quality often associated with these fractures. The objective of this study is to investigate the rates of reoperation and trochanteric nonunion using a third-generation cable-plate system at one center.Methods
Thirty-five patients, mean age 72.9 years (range 46-98 years) with 24 women and 11 men, underwent fixation of their fractured greater trochanter using a third-generation cable-plate system. The indications were: periprosthetic fracture (n = 17), complex primary arthroplasty (n = 5), and complex revision arthroplasty (n = 13). Primary outcomes included rates of reoperation and radiographic union.Results
At a mean follow-up of 2.5 years, trochanteric union rate was 62.9% with nonunion rate of 31.4%, and fibrous union in 5.7%. In regard to quality of initial apposition, only 40% achieved a perfect bone on bone reduction. Ten patients (28.6%) had evidence of wire breakage. Five patients (14.3%) required reoperation and removal of the internal fixation because of lateral hip pain.Conclusion
Fixation of the trochanteric fractures remains a challenge with a relatively high reoperation rate. Poor bone quality and capacity to maintain a stable reduction continue to make this complication after total hip arthroplasty a difficult problem to solve. 相似文献10.
Shigeo Fukunishi Shoji Nishio Yu Takeda Tomokazu Fukui Yuki Fujihara Shohei Okahisa Shinichi Yoshiya 《Journal of orthopaedic science》2017,22(5):898-904
Background
The number of hemodialysis patients has been progressively increasing in our country. On the other hand, chronic hip arthropathy associated with long-term hemodialysis is a devastating problems affecting patients' quality of life. In our previous study, we proposed a classification system for radiological abnormalities seen in hemodialysis-related hip lesions. The purpose of the study was to propose the surgical strategy for hip disorders caused by long-term hemodialysis.Methods
Patients with a history of hemodialysis for more than 10 years, 191 hip lesions in 165 consecutive patients who visited our institute due to hip symptoms. Various abnormalities were identified in 116 out of 191 hips. A retrospective assessment of the patient record and radiographs was performed for the included subjects examining the natural course of the disease process as well as the results of surgical treatment.Results
Seventy-six hip lesions (69.0%) were conservatively managed at the time of the initial visit. Surgeries were performed for 75 hips (64.7%) during the study period. Among those, surgical treatment was indicated for 40 hips at the time of the initial visit. On the other hand, surgeries were performed for 35 hips during the subsequent follow-up period due to progression of the disease process.Conclusions
Based on the analysis of our surgical experiences by the retrospective chart review, we have established a flowchart of the treatment strategy for chronic hip arthropathy in long-term hemodialysis patients.Study design
This study is retrospective clinical study. 相似文献11.
E.A. Hassan T.Z. Ali A. Abdulbaki I.A. Ibrahim H.M. Almanae H.A. Aleid 《Transplantation proceedings》2017,49(8):1729-1732
Introduction
Isolated microscopic hematuria (IMH) is not uncommon in potential kidney donors.Aim
The aim was to study the kidney biopsy findings of potential kidney donors with IMH and the impact of the histopathologic diagnoses on the decision to accept or decline such donors from kidney donation.Methods
In this retrospective study, all the potential kidney donors with IMH were identified from the medical records of patients who underwent kidney biopsies between January 2010 and December 2016.Results
Forty-five such individuals were identified. The mean age of these potential donors was 32.6 years and 76% were male. All of them had normal blood pressure and no significant proteinuria. Seventeen (38%) biopsies showed histopathologic abnormalities; thin basement membrane disease (n = 13; 28%) was the most common cause followed by immunoglobulin (Ig)A nephropathy (n = 4; 9%). Donors with abnormal biopsy findings were excluded from donation. However, 62% of the potential donors had normal kidney biopsy findings and were accepted for kidney donation.Conclusion
IMH justifies extensive work-up including kidney biopsy to identify donors who may have underlying significant glomerular pathology excluding them from kidney donation. On the other hand, kidney biopsy also helps in accepting the donors if it does not show significant abnormality. 相似文献12.
W.M. Bennett E.L. Simonich A.M. Garre K.M. McEvoy M.A. Farinola T.D. Batiuk 《Transplantation proceedings》2017,49(8):1779-1782
Introduction
Between January 2013 and September 2015, 135 consecutive renal transplant patients were screened prospectively with ultrasound for renal cell carcinoma (RCC).Results
Eighteen ultrasound abnormalities were identified with 4 solid lesions detected. Fifty-six other patients were screened retrospectively by referring nephrology groups, with 6 additional malignancies found.Conclusion
As a result of our data, we recommend and have instituted annual ultrasound screening of native kidneys in all renal transplant patients. 相似文献13.
Grant H. Young Matthew P. Abdel Richard L. Amendola Devon D. Goetz David G. Lewallen John J. Callaghan 《The Journal of arthroplasty》2017,32(11):3480-3483
Background
The authors and others have previously described the technique of cementing constrained liners into secure cementless acetabular shells and reported the short-term, average 3.9-year follow-up, using that technique. The purpose of the present study was to report the minimum 15-year follow-up of this same cohort.Methods
Between 1988 and 2000, 31 consecutive constrained liners of one design were cemented into well-fixed, well-positioned cementless acetabular shells at 3 institutions. Average age at surgery was 72 years (range, 31-91 years). Indications for the procedure were recurrent hip dislocation in 16 cases and intraoperative instability in 15 cases. Patients were evaluated for revision for failure of the device and revision for any reason.Results
At minimum 15-year follow-up, there was 1 patient lost to follow-up. Three hips (9.7%) were revised for failure of the device and 5 hips (16.1%) were revised for any reason.Conclusion
At minimum 15-year follow-up, considering the complexity of cases, there was excellent medium-term durability of this construct. 相似文献14.
Leena Ristolainen Jyrki A. Kettunen Urho M. Kujala Ari Heinonen Dietrich Schlenzka 《Journal of orthopaedic science》2017,22(4):652-657
Background
There is no data available on the radiographic development of the Scheuermann's deformity. Our purpose was to investigate radiographic deformity progression and the relation between kyphosis progression and clinical outcome in patients with untreated Scheuermann's kyphosis.Methods
Thoracic kyphosis (Th4-Th12) was measured from standing lateral radiographs in 19 patients at baseline and after mean 46-year follow-up. Mean age at baseline was 19.2 and at follow-up 64.7 years. At follow-up, height, weight, hand grip strength, and hamstring tightness were measured, and sit-to-stand and walking tests were performed. Additionally general health and quality of life questionnaires were administered.Results
The mean thoracic kyphosis increased from 46° (range 25°–78°) at baseline to 60° (34°–82°) (p < 0.001) at follow-up. Mean of the vertebrae wedge increased from 8.8° to 9.9° (p = 0.046). There was no correlation between extent of kyphosis progression and function at follow-up.Conclusions
Among patients with Scheuermann's disease the degree of radiographic deformity progressed slightly during long-term follow-up. Progression did not predict symptoms. 相似文献15.
Keiji Wada Ryo Tamaki Mitsuru Yui Daisuke Numaguchi Yasuaki Murata 《Journal of orthopaedic science》2017,22(2):213-217
Background
C1 lateral mass screw was widely used for fixation of the upper cervical spine. However, massive bleeding from the C1–2 venous plexus is sometimes encountered. In this study, we proposed an alternate method for C1 lateral mass screw insertion, which involves insertion of the screws caudally from the C2 nerve root to reduce bleeding from C1–2 venous plexus.Methods
Seven patients with atlantoaxial lesions were included in this study. The mean age at surgery was 65.9 (34–82) years. The mean follow-up period was 23.1 (12–38) months. All patients underwent atlantoaxial fusion with C1 lateral mass screws, which were inserted caudally from the C2 nerve root. All screws were inserted using O-arm based navigation system. Operative time, blood loss, C2 nerve root injury and perioperative complications were investigated. The accuracy of C1 screws and bone union were evaluated using postoperative computed tomography.Results
A total of 13 C1 lateral mass screws were inserted using this method. The mean operative time was 224 (144–305) min. The mean blood loss was 209 (100–357) g. One perioperative complication was observed, which was recurrent laryngeal nerve palsy. There were no vertebral artery or spinal cord injuries. No case of massive bleeding from the C1–2 venous plexus was observed. One patient complained of postoperative occipital neuralgia, which disappeared in 2 weeks. No malposition of C1 lateral mass screws was observed on postoperative computed tomography. Bone union was observed in all patients.Conclusion
The C1 lateral mass screw insertion caudally from the C2 nerve root may become an alternate method for insertion of C1 screws. 相似文献16.
Omar A. Behery Sean M. Kearns Justin M. Rabinowitz Brett R. Levine 《The Journal of arthroplasty》2017,32(5):1510-1515
Background
The ideal fixation for modern tibial components in total knee arthroplasty (TKA) remains controversial with uncertainty on whether cementless implants can yield equivalent outcomes to cemented fixation in early follow-up.Methods
A series of 70 consecutive cases with reverse hybrid cementless fixation were matched to 70 cemented cases from 2008 to 2015 based on implant design and patient demographics.Results
Cementless TKA demonstrated greater aseptic loosening (7 vs 0, P = .013) and revision surgery (10 vs 0, P = .001) than cemented fixation within 5 years of follow-up, but with no clinically significant differences in outcome scores.Conclusion
It remains unclear whether early aseptic loosening in cementless TKA can be reduced with enhanced adjunct fixation and what proportion of early failure justifies the potential lifelong fixation through biologic ingrowth of cementless tibial components. 相似文献17.
Y. Pecoraro C. Carillo D. Diso S. Mantovani G. Cimino T. De Giacomo P. Troiani M. Shafii L. Gherzi D. Amore E.A. Rendina F. Venuta M. Anile 《Transplantation proceedings》2017,49(4):695-698
Background
Lung transplantation (LT) is only therapeutic option for patients affected by chronic respiratory failure. Chronic rejection, also known as bronchiolitis obliterans syndrome (BOS), is still the main cause of death and the most important factor that influences post-transplantation quality of life. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Extracorporeal photopheresis (ECP) seems to reduce the rate of lung function decline in transplant recipients with progressive BOS.Methods
From 1991 until now, 239 LTs were performed at our center. Fifty-four patients (22.5%) developed BOS; 15 of these (27.7%) were treated with ECP. At the beginning of the treatment, all patients showed a mean decline of forced expiratory volume in 1 second (FEV1) from baseline values of 45.8% ± 17.2%; 2 patients were in long-term oxygen therapy.Results
Mean follow-up from November 2013 to June 2016 was 11.6 ± 7 months. Twelve patients (80%) showed lung function stabilization with an FEV1 range after treatment between ?6% to +8% from the pre-treatment values. We did not report any adverse effects or increase of infections incidence.Discussion
ECP seems to be an effective and well-tolerated therapeutic option for LT patients with BOS in terms of stabilization of lung function and increased survival. 相似文献18.
Jared S. Bookman Ian D. Kaye Kevin K. Chen Fredrick F. Jaffe Ran Schwarzkopf 《The Journal of arthroplasty》2017,32(8):2587-2589
Background
Short-term and intermediate-term wear rates for highly cross-linked polyethylene (HCLPE) liners in total hip arthroplasty (THA) are significantly lower than published rates for traditional polyethylene liners. The aim of this study was to report the longest-to-date follow-up of a specific HCLPE liner.Methods
A series of 35 THAs using a specific HCLPE liner were reviewed. Anteroposterior radiographs were reviewed for femoral head penetration, the presence of femoral and/or acetabular osteolysis, long-term survival, total wear, and wear rates in all patients.Results
The average patient age at time of surgery was 70 years with an average follow-up of 10 years (118 months; range, 7.2-13.4 years). The mean wear rate in our cohort was 0.07 mm/y. Total wear was 0.71 mm over the study period. No hips showed evidence of osteolysis in any zones. Survivorship at latest follow-up was 100% with all-cause revision as an end point.Conclusion
The wear rate of HCLPE liners continues to be lower than published wear rates for traditional polyethylene and continues to reaffirm the acceptably low wear rates using HCLPE acetabular liner in primary THA. 相似文献19.
M. Lejman K. Drabko B. Styka D. Winnicka M. Babicz I. Jaszczuk J.R. Kowalczyk 《Transplantation proceedings》2017,49(8):1903-1910
Background
In the light of an increasing number of hematopoietic stem cell transplantations and more frequent use of reduced-intensity conditioning as preparative regimens for hematopoietic stem cell transplantation, post-transplant cell chimera monitoring is considered a necessity.Methods
The quantitative fluorescence polymerase chain reaction method, along with the commercial AmpFSTR SGMPlus kit, was applied in research on hematopoietic chimeras.Results
The total of 102 patients who had undergone allogenic transplantations were investigated. Chimerism monitoring was commenced on the seventh day after transplantation and lasted up to 12 years in some cases, according to the instituted schedule.Conclusions
The kit has been shown to be fully sufficient for determining genetic profiles of recipients and donors and selecting informative markers. The method has been proven effective and satisfactory for assessing quantitative chimeras. 相似文献20.
Constantine N. Antonopoulos Spyridon N. Mylonas Konstantinos G. Moulakakis Theodoros N. Sergentanis George S. Sfyroeras Andreas M. Lazaris John D. Kakisis Spyros N. Vasdekis 《Journal of vascular surgery》2017,65(1):234-245.e11