ABSTRACT
Numerous studies have reported on the adverse outcome of patients who sustain job-related injuries. In addition, studies have reported poor outcomes in patients receiving Workers' Compensation who undergo elective surgery. This study sought to determine the influence of Workers' Compensation on the outcome of patients who had undergone primary total hip arthroplasty. Between January 1984 and December 1996, 44 patients (48 hips) were studied. Of these, 17 were men and five were women with a mean age of 45 years (range, 27-76 years) at the time of surgery. These patients were receiving compensation benefits and were matched directly with a group of 22 patients who had 24 arthroplasties and were not receiving compensation. After a mean final followup of 77 months (range, 25-125 months), the compensation group had a mean Harris hip score of 86 points (range, 54-95 points). The matched control group had a mean Harris hip score of 92 points (range, 79-100 points) at a mean final duration of followup of 80 months. Two patients (9%) had undergone revision surgery for aseptic loosening at 28 and 67 months. The percentage of patients with good or excellent results did not differ significantly between the two groups. Based on these findings, the authors think that Workers' Compensation does not negatively influence the outcome of total hip arthroplasty.
Subject(s)
Arthroplasty, Replacement, Hip , Workers' Compensation , Adult , Aged , Female , Follow-Up Studies , Hip Joint/diagnostic imaging , Humans , Male , Middle Aged , Radiography , Reoperation , Treatment OutcomeABSTRACT
Sixteen patients with infected total knee arthroplasties (4 postoperative and 12 late hematogenous) were treated by arthroscopic irrigation and débridement. All patients had < or = 7 days of knee symptoms, and there were no radiographic signs of osteitis or prosthetic loosening. Six of the 16 original total knee arthroplasties (38%) did not need prosthesis removal at a mean follow-up of 64 months (range, 36-151 months). Ten other knees were treated with irrigation, débridement, and hardware removal within 7 weeks of the latest procedure used to try to retain components. Two (13%) of these cases ultimately required an arthrodesis for persistent infection. Although we still believe that this method is preferable to resorting immediately to implant removal for acute infections, arthroscopic débridement was less efficacious for most situations when compared with open treatment. We would use arthroscopic irrigation and débridement only under selected circumstances (medically unstable or anticoagulated patients).
Subject(s)
Arthroscopy , Debridement/methods , Knee Prosthesis/adverse effects , Prosthesis-Related Infections/therapy , Staphylococcal Infections/therapy , Streptococcal Infections/therapy , Aged , Aged, 80 and over , Escherichia coli Infections/surgery , Escherichia coli Infections/therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis-Related Infections/surgery , Staphylococcal Infections/surgery , Streptococcal Infections/surgery , Therapeutic IrrigationABSTRACT
Enigmatic thigh pain remains a difficult problem to treat after total hip arthroplasty. This article reports on the use of strut cortical allografting for the treatment of recalcitrant enigmatic thigh pain following total hip arthroplasty in patients with a well-fixed cemented or cementless femoral component.
Subject(s)
Femur/transplantation , Hip Prosthesis , Pain, Postoperative/surgery , Adult , Bone Transplantation/methods , Female , Humans , Male , Middle Aged , ThighABSTRACT
The purposes of this study were to evaluate the efficacy of intraoperative surgeon-elected reinfusion drain placement and to determine whether drainage at 90 minutes is useful in predicting the need for a reinfusion drain. In the standard drain hip arthroplasty group, 6 of 30 patients (20%) received a reinfusion, similar to the 11 of 41 patients (27%) in the reinfusion drain group. In the total knee arthroplasty group, 38 of 45 patients (84%) in the standard group had reinfusion, similar to the 23 of 27 patients (85%) in the reinfusion drain group. The surgeon could not predict intraoperatively which patients would need a subsequent reinfusion drain. However, in more than 94% of the cases, one could know by 90 minutes postoperatively whether a reinfusion would be necessary. We believe that a drain that can be converted to a reinfusion drain in the recovery room would be the most cost-effective drain system.
Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Blood Transfusion, Autologous/methods , Drainage , Intraoperative Care , Adult , Aged , Aged, 80 and over , Blood Loss, Surgical , Cost-Benefit Analysis , Female , Humans , Male , Middle AgedABSTRACT
A novel set of putrescine-based segmented polyurethanes was synthesized using 1,4-butane-diisocyanate and phosphoester diols, and was characterized for its potential as a degradable biomaterial. These poly(phosphoester-urethanes) (PPU) were flexible polymers with ultimate tensile strength (UTS) from 2 to 3 MPa, elongations up to 80% and tan delta near 0.15. The incorporation of phosphoester bonds in the backbone of the polymer by using bis(2-hydroxyethyl)phosphite (BGP) and bis(6-hydroxyhexyl)phosphite (BHP) as chain extenders resulted in hydrolytic degradation which was evaluated in vitro. By varying the content of the phosphoester diol BGP, degradation rate, as followed by mass loss and GPC, could be modulated. Polymers based on the more hydrophobic monomer, BHP, showed slower degradation than corresponding BGP based polymers. Tensile properties of PPU-B2 after 22 days in vitro degradation show more than a 50% drop in UTS and ultimate elongation, likely caused by void spaces left behind in the polymer after mass loss and swelling. The attachment of a drug, PAS, pendant to the phosphoester group of the PPU was demonstrated. PAS was linked via the spacer 4-hydroxybenzaldehyde, and free, intact drug was released in about 5 h from a thin film.
