Total hip arthroplasty in patients receiving Workers' Compensation.

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.

Cranial nerve palsy as a complication of operative traction.

STUDY DESIGN: Case report. OBJECTIVE: This report documents one case of diplopia from abducens (sixth cranial) nerve palsy after spinal surgery using a Jackson table and cranial traction. SUMMARY OF BACKGROUND DATA: Cranial nerve deficits have frequently been described in the orthopedic literature after trauma, halo pelvic traction, and halo skeletal fixation. The theorized mechanism of injury to the abducens nerve involves stretch or traction force, which causes localized ischemia or a change in nerve position. An extensive literature search failed to show this type of injury using Gardner-Wells tongs in conjunction with the Jackson table. METHODS: This is a case report that included a chart review, examination of the patient, and a literature search. RESULTS: The patient had complete spontaneous resolution of abducens nerve dysfunction within 6 months. CONCLUSIONS: It is important for the surgeon to be aware of this potential complication and to inform patients who have diplopia that develops from abducens nerve palsy that most of these cranial nerve deficits spontaneously improve.

Total knee arthroplasty in patients receiving Workers' Compensation.

The poor outcomes in patients who have a low-back injury that was sustained while they were on the job have been well described in many studies. The purpose of the current study was to determine the influence of Workers' Compensation on the outcome of total knee arthroplasty in forty-two patients who had been managed between January 1980 and December 1993. There were thirty-two men and ten women, and the mean age at the time of the operation was forty-eight years (range, twenty-nine to sixty-eight years). These patients were directly matched with a group of forty-two patients who were not receiving compensation. The two groups were matched with regard to nine parameters: age, gender, obesity index, preoperative deformity in the coronal plane, preoperative level of symptoms, preoperative radiographic severity according to the criteria of Ahlbäck, method of fixation, number of previous procedures, and duration of follow-up. After a mean duration of follow-up of eighty months (range, forty-eight to 178 months), the patients who were receiving compensation had a mean Knee Society score of 64 points (range, 25 to 100 points). Twelve (29 per cent) of the patients in this group had an excellent or good clinical result, and thirty (71 per cent) had a fair or poor result or had had a revision. The patients who were not receiving compensation had a mean Knee Society score of 93 points (range, 57 to 100 points) after a similar duration of follow-up. Thirty-seven patients (88 per cent) in this group had an excellent or good clinical result, and five (12 per cent) had a fair or poor result or had had a revision; the difference between the two groups with regard to fair or poor results and revisions was significant (p < 0.01). With the numbers available, no significant differences could be detected between the two groups with regard to objective measurements of range of motion and stability or with regard to radiographic alignment, the presence of radiolucent lines, or the shedding of beads. On the basis of our findings, we believe that surgeons should be aware that Workers' Compensation is one of several variables that may have an untoward influence on the perceived outcome of total knee arthroplasty.