The Presumption of Guilt Dorr, Lawrence D., MD; Ranawat, Chitranjan S., MD; Rothman, Richard H., MD, PhD
The Journal of arthroplasty,
4/2011, Letnik:
26, Številka:
3
Journal Article
We hypothesized that large ceramic head articulation against highly cross-linked polyethylene in young and active patients would have high safety for dislocation and fracture and low wear rates. Wear ...analysis of 32 hips with 36-mm Delta ceramic femoral heads (CeramTec, Plochingen, Germany) on highly cross-linked polyethylene was performed using Roman software (Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom). The mean age was 56.8 ± 6.5 years, and the mean follow-up was 2.6 ± 0.5 years. The mean wear rate was 0.022 ± 0.11 mm/year after the bedding-in period. There were no reoperations. The early results of large ceramic heads in young and active patients demonstrate high safety and efficacy.
Abstract This randomized trial assessed the effect of recombinant human erythropoietin (EPO) vs preoperative autologous donation (PAD) on postoperative vigor and handgrip strength in patients ...undergoing primary total joint arthroplasty. Adults with baseline hemoglobin level of 11 to 14 g/dL received EPO (600 IU/kg once weekly for 4 doses, n = 130) or PAD (n = 121) before primary, unilateral hip or knee arthroplasty. Mean changes in vigor score and handgrip strength from baseline were not significantly different between treatment groups. Multivariate analyses found a significant treatment effect favoring EPO over PAD for vigor, but not for handgrip strength. Patients in the EPO group had higher hemoglobin levels and required fewer transfusions. Both treatments were well tolerated. Additional study is needed to elucidate the influence of blood management strategies on postoperative vigor.
The number of periprosthetic femoral fractures is on the rise with the increasing prevalence of primary and revision hip arthroplasty and the longer life expectancy of the population. The management ...of these fractures is difficult. We describe the preoperative planning and the operative technique for the management of Vancouver B2 and B3 fractures, using a tapered, fluted, modular, distally fixed, cementless stem. We reviewed the results of 14 patients who underwent revision arthroplasty with the above technique with Vancouver type B2 and B3 femoral fractures. The average age of the patient was 67.3 years. There were 12 Vancouver type B2 and 2 Vancouver type B3 fractures. The mean follow-up time was 3.34 years. The average operative time was 194 minutes and the average blood loss was 1007 mL. At the most recent follow-up of the patients, the mean Harris hip score was 83.9. Radiographic evaluation revealed periprosthetic fracture union in all the cases and no hips showed subsidence beyond 2 mm. There were 2 cases of dislocation of the hip joint and 2 cases of superficial wound infection. This technique has proven to be reliable in the treatment of difficult fractures in this population.
Abstract In this prospective randomized study, patients undergoing total hip (THA) or knee arthroplasty (TKA) were randomized to either a study group receiving periarticular injections or a control ...group receiving patient-controlled analgesia with or without femoral nerve block (TKA patients). All patients received a comprehensive multimodal perioperative protocol. Pain, recovery of functional milestones, and overall satisfaction were assessed. The THA study group demonstrated significantly lower average pain scores and higher overall satisfaction than the control group. There was no significant difference in pain scores between the study and control groups in the TKA cohort. Both study groups demonstrated lower narcotic usage and side effects as well as improved early functional recovery. Periarticular injection with a multimodal protocol was shown to safely provide excellent pain control and functional recovery and can be substituted for conventional pain control modalities.
How I Manage Pain After Total Knee Replacement Ranawat, Chitranjan S., MD; Ranawat, Amar S., MD; Parvataneni, Hari K., MD
Seminars in arthroplasty,
2008, Letnik:
19, Številka:
3
Journal Article
Recenzirano
A comprehensive, perioperative multimodal pain protocol for total knee replacement including use of a periarticular injection is described here. An appropriately designed and implemented multimodal ...pain protocol will reduce postoperative pain levels, need for narcotic medication, side effects, and adverse events while improving functional recovery (including ambulation, discharge from hospital, and range of motion), and patient satisfaction.
Abstract The optimal surface finish on cementless total hip arthroplasty is still a matter of debate. 145 hips in 130 patients with hybrid total hip arthroplasty using a hemispherical, titanium ...plasma-sprayed cup were followed for an average of 8.5 years. The average age was 63 years, and the average weight was 165 lb. Three hips were revised for polyethylene wear and synovitis/osteolysis. In all 3 cases, the acetabular component remained well fixed. Radiographically, 5 hips had femoral osteolysis, and 5 sockets had osteolysis in zone 2, with 4 in zone 1. There were no cases of progressive lucent lines, and no acetabular components were revised. Plasma-sprayed acetabular components remain durable up to 12 years. Moreover, in cases with wear particle overload and osteolysis, fixation was maintained at revision surgery.
In Reply Crawford, Ross W., DPhil, FRACS; Ranawat, Chitranjan S., MD; Rothman, Richard H., MD, PhD
The Journal of arthroplasty,
2010, Letnik:
25, Številka:
4
Journal Article
In Reply Crawford, Ross W., DPhil; Ranawat, Chitranjan S., MD; Rothman, Richard H., MD, PhD
The Journal of arthroplasty,
2010, Letnik:
25, Številka:
4
Journal Article
