ABSTRACT
In general, longer operative times and in some cases increased blood requirements can be expected with TKA in patients with juvenile rheumatoid arthritis. Complications also are more frequent. Pain relief is usually good to excellent, and function and deformity are significantly improved. Range of motion after TKA for juvenile rheumatoid arthritis is usually less than that obtained in osteoarthritis, but still allows for dramatic improvements in performing activities of daily living (Figure 3).
Subject(s)
Arthritis, Juvenile/surgery , Arthroplasty, Replacement, Knee/methods , Age Factors , Arthritis, Juvenile/diagnostic imaging , Arthritis, Juvenile/drug therapy , Child , Humans , Knee Prosthesis , Preoperative Care/methods , RadiographyABSTRACT
UNLABELLED: Range of motion after total knee arthroplasty is an important variable in determining clinical outcome. The goal of this study was to assess range of motion across five types of posterior-stabilized knee prostheses used sequentially in the same institution during 17 years. The hypothesis was that absolute flexion would improve in newer models of this basic prosthesis design. Only primary knee arthroplasties in patients with osteoarthritis were evaluated. A retrospective analysis was done. Three hundred fifty-eight knees with osteoarthritis were reviewed. The average arc of motion was 103 degrees before surgery and 111 degrees after surgery. Absolute flexion was clinically similar but improved from before surgery (110 degrees ) to after surgery (113 degrees ). No difference was found when comparing improvements in range of motion among the different types of prostheses used. This study did not show that any knee system made a difference in determining the final range of motion postoperatively. Height emerged as a predictive factor of absolute flexion. Preoperative range of motion is the most important variable in determining improvements in range of motion, with height playing a secondary role. LEVEL OF EVIDENCE: Prognostic study, Level II-1.
Subject(s)
Arthroplasty, Replacement, Knee/instrumentation , Arthroplasty, Replacement, Knee/statistics & numerical data , Knee Joint/physiopathology , Knee Prosthesis/statistics & numerical data , Range of Motion, Articular , Aged , Contracture/etiology , Female , Humans , Knee Prosthesis/adverse effects , Male , Middle Aged , Osteoarthritis, Knee/surgery , Outcome and Process Assessment, Health Care , Retrospective Studies , Treatment OutcomeABSTRACT
This article is the first to specifically address blood transfusions associated with surgical treatment of proximal humerus fractures. In our study, we retrospectively reviewed charts of all patients admitted to our institution with a diagnosis of proximal humerus fracture from January 1, 1994, to December 31, 1997. The transfusion rate for patients who sustained a proximal humerus fracture was 15%. Compared with patients treated nonoperatively, patients who underwent a surgical procedure were not at increased risk for requiring transfusion. Age, hematocrit level on admission, treatment method, and estimated amount of blood loss in patients who underwent a surgical procedure varied significantly between those who received a transfusion and those who did not. Certain characteristics placed patients at increased risk for requiring transfusion--age older than 60, admission hematocrit level less than 33%, and hemiarthroplasty as definitive surgical treatment. This information is important both in educating patients and their families and in making management decisions.
