ABSTRACT
A prospective randomized study was performed on 20 patients undergoing one-stage bilateral knee arthroplasty. One knee was exposed using a standard median parapatellar arthrotomy and the other knee with a subvastus arthrotomy. All patients underwent quantitative strength testing before surgery and at 1 week, 1 month, and 3 months after surgery. The knees were also evaluated for range of motion, and patients, who were blinded as to the approach used, completed questionnaires at each evaluation period as to their preference, if any, regarding knee pain and level of function. There was no difference in the range of motion between knees exposed with the paramedian or subvastus arthrotomy at any time period. The subvastus knees demonstrated significantly greater strength at the 1-week and 1-month intervals, but there was no strength difference at the 3-month interval. There were more lateral releases performed in the paramedium knees, and three minor complications were related to the subvastus approach. Patients who expressed a preference chose the subvastus knee 4:1 over the paramedian knee. The subvastus approach offers a reasonable alternative to the paramedian arthrotomy and preserves greater quadriceps strength in the early postoperative period.
Subject(s)
Knee Prosthesis/methods , Osteoarthritis/surgery , Aged , Female , Follow-Up Studies , Humans , Knee Joint/physiology , Male , Osteoarthritis/epidemiology , Prospective Studies , Range of Motion, Articular/physiology , Time FactorsSubject(s)
Cervical Vertebrae , Spondylolisthesis , Spondylolysis , Adult , Female , Humans , Spondylolisthesis/congenital , Spondylolisthesis/diagnosis , Spondylolisthesis/surgery , Spondylolisthesis/therapy , Spondylolysis/congenital , Spondylolysis/diagnosis , Spondylolysis/surgery , Spondylolysis/therapy , Tomography, X-Ray ComputedABSTRACT
An unusual case of primary osteomyelitis of the acetabulum caused by Aspergillus flavus in a presumed immunocompetent adult is presented. Review of the literature found 25 additional cases of aspergillar osteomyelitis, which occurred predominantly in hosts with either inborn or acquired immune defects. There were notable differences between the adult and the pediatric cases in causation, clinical presentation, and treatment regimens. In children, the underlying cause was usually severe immunocompromise; among adults, the majority of cases occurred in hosts presumed to be immunocompetent. In all but one case, the children were treated with antifungal chemotherapy alone, whereas the adult patients nearly always received surgical debridement in conjunction with chemotherapy.
