Abstract:
UNLABELLED:There are many causes of total knee arthroplasty failure, and an accurate preoperative diagnosis is essential to optimize the results of revision surgery. We discuss our standard pre-operative evaluation routine and we retrospectively reviewed the last 295 patients who underwent revision total knee arthroplasty to establish the clinical value of the most commonly performed investigations used to diagnose sepsis. Routinely performed preoperative investigations include erythrocyte sedimentation rate, C-reactive protein, microbiology, bacteriology cultures of preoperative knee aspirations, and intraoperative tissue bacteriology cultures. Each investigation was compared with the reason for revision (eg, septic or aseptic) to establish the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of each. 79 cases (26.8%) were revised for infection. Of the investigations, the ESR had a sensitivity of 0.63, a specificity of 0.55, a positive predictive value of 0.39, a negative predictive value of 0.77, and an accuracy of 0.57. The respective values for C-reactive protein were 0.6, 0.63, 0.45, 0.76, and 0.62, and 0.53, 0.94, 0.75, 0.85, and 0.83 for intraoperative tissue culture. There was no preoperative investigation accurate enough to be solely relied on for diagnosing infection. We believe that clinical findings and the routine use of simple tests such as C-reactive protein, ESR, and knee aspiration yield predictable results. LEVEL OF EVIDENCE:Prognostic study, level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Baré J,MacDonald SJ,Bourne RBdoi
10.1097/01.blo.0000218727.14097.d5subject
Has Abstractpub_date
2006-05-01 00:00:00pages
40-4eissn
0009-921Xissn
1528-1132pii
00003086-200605000-00010journal_volume
446pub_type
杂志文章abstract::The clinical data, failure pattern, symptoms, roentgenographic findings, and failure mechanism of a series of 25 metal-backed patellar component failures are summarized. Diagnosis of implant failure was unknown prior to arthrotomy in seven of 25 cases (28%). Clinical findings and history were not helpful in making the...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-11-01 00:00:00
abstract:BACKGROUND:Although morbid obesity is considered a modifiable risk factor for periprosthetic joint infection (PJI), there is no consensus regarding an appropriate threshold for body mass index (BMI) above which a high risk for infection may outweigh the benefits of surgery. QUESTIONS/PURPOSES:(1) Is there a BMI cutoff...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999.0000000000000141
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Large-diameter femoral heads for metal-on-metal THA hold theoretical advantages of joint stability and low bearing surface wear. However, recent reports have indicated an unacceptably high rate of wear-associated failure with large-diameter bearings, possibly due in part to increased wear at the trunnion int...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-3244-8
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Acetabular version influences joint mechanics and the risk of impingement. Cross-sectional studies have reported an increase in acetabular version during adolescence; however, to our knowledge no longitudinal study has assessed version or how the change in version occurs. Knowing this would be important beca...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000000900
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Childhood obesity is a growing problem in America. Orthopaedic surgeons have an opportunity to interact with communities to educate children about healthy eating and physical activity. The American Academy of Orthopedic Surgeons (AAOS) Leadership Fellows Program [1] Class of 2012 created a presentation for A...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-012-2647-2
更新日期:2013-04-01 00:00:00
abstract::As degenerative changes progress in the aging population, more patients will present with degenerative spondylolisthesis. The clinical picture is usually of a woman older than 50 years of age with a degenerative lumbar spondylolisthesis at L5 with symptoms of neurogenic claudication or radiculopathy. Imaging studies w...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:2001-03-01 00:00:00
abstract::Molecular diagnostic strategies have been implemented to enhance the treatment of musculoskeletal infections. Once primarily a research tool, molecular-based assays, have become accepted clinical tests for the genomic detection of certain pathogens involved in bone and joint infections. Currently, culture remains the ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000175126.37343.44
更新日期:2005-08-01 00:00:00
abstract::There has been a resurgence in the treatment of end-stage tibiotalar arthritis with prosthetic replacement. This procedure has highlighted numerous complications including malleolar fracture. We wanted to determine the clinical relevance of malleolar fracture with the two most commonly used implants in the United Stat...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000131202.58536.89
更新日期:2004-07-01 00:00:00
abstract::Long-term results of total hip replacement by low-friction arthroplasty show a consistent and reproducible outcome for relief of pain, increased mobility, and function in most patients followed for five to 15 years after surgery. In a review of 1009 consecutive operations, the rate of reoperation and potential failure...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-12-01 00:00:00
abstract::From 1977 to 1982, 13 patients were diagnosed with avascular necrosis of the femoral head. The diagnoses were made with a combination of clinical exams, radiographs, tomograms, and Tc99 bone scans. One hip was classified as Ficat Stage I, 9 as Stage II, and 5 as Stage III. There were 11 male and 2 female patients with...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1994-09-01 00:00:00
abstract::In experimental fractures in rabbits, a decrease in blood volume associated with anemia delays healing, but uncomplicated normovolemic anemia has no adverse effect. For the purpose of stimulating the repair process in normovolemic anemia individuals blood transfusions would be ineffectual. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-03-01 00:00:00
abstract::Venous drainage from the femur of adult animals is not interrupted by occlusion of the blood supply in the soft tissue surrounding the diaphysis of the bone. Previous studies have shown that the metaphyseal drainage system is capable of rapidly transporting particles up to 100 mu in diameter to the lungs. The present ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00
abstract::In 15 documented cases, subluxation or dislocation of the hip was discovered months or years after previous multiple normal physical examinations. The examiners were unique in that six were professors specializing in childrens' orthopedics, four were board-certified orthopedists, and five were pediatricians. An increa...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1986-02-01 00:00:00
abstract:BACKGROUND:As new Patient-Reported Outcomes Measurement Information System (PROMIS) instruments are incorporated into clinical practice, determining how large a change on these instruments represents a clinically relevant difference is important; the metric that describes this is the minimum clinically important differ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000000419
更新日期:2018-10-01 00:00:00
abstract::A massive solitary tophus containing calcium pyrophosphate dihydrate (CPPD) crystals was resected from the distal clavicle and proximal acromion of a 62-year-old man who presented with a painful shoulder mass. The diagnosis was confirmed histologically and by X-ray diffraction. CPPD crystal deposition was found within...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-02-01 00:00:00
abstract:BACKGROUND:MicroRNAs are small, noncoding RNAs that regulate the expression of posttranslational genes. The presence of some specific microRNAs has been associated with increased risk of both local recurrence and metastasis and worse survival in patients with osteosarcoma. Pathologic fractures in osteosarcoma are consi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000000867
更新日期:2019-09-01 00:00:00
abstract::A follow-up study was carried out on 20 patients with a Hitchcock type of biceps tenodesis performed during the past seven years at the Hospital for Special Surgery. Thirteen cases were diagnosed as biceps tendinitis and seven as biceps instability. At follow-up, there was a 30% failure rate; the failures were related...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-04-01 00:00:00
abstract:BACKGROUND:CT pulmonary angiography (CTPA) has become widely adopted to detect pulmonary embolism (PE) after total joint arthroplasty (TJA). CTPA is a sensitive tool, which has the ability to detect emboli that may be clinically insignificant. This may lead to iatrogenic harm from overtreatment. QUESTIONS/PURPOSES:The...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-3041-4
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Periprosthetic osteolysis is an increasingly prevalent complication of TKA. To reduce the polyethylene wear and periprosthetic osteolysis, particularly in young patients, the design of the contemporary fixed-bearing TKAs has been modified and mobile-bearing TKAs have been introduced. QUESTIONS/PURPOSES:We a...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1336-2
更新日期:2010-11-01 00:00:00
abstract::Computer-aided design and computer-aided manufacturing (CAD/CAM) systems for the design and manufacture of limb prostheses have recently become commercially available. However, rigorous evaluations of these systems have not been performed to determine whether they produce sockets that fit as well as or better than soc...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-07-01 00:00:00
abstract::Forty-three consecutive patients who did not have healing of tibial or femoral diaphyseal and metaphyseal fractures and osteotomies for at least 9 months after injury or surgery were examined prospectively for use of high-energy extracorporeal shock waves. Former treatment modalities (cast, external fixator, plate ost...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章
doi:10.1097/00003086-200106000-00014
更新日期:2001-06-01 00:00:00
abstract:BACKGROUND:Osteosarcoma is a rare complication of Paget's disease with a very poor prognosis. Treatment is controversial: the older age of the patients affected by Paget's disease may limit the use of chemotherapy and axial involvement may limit the practicality of surgery. QUESTIONS/PURPOSES:The purposes of this stud...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1473-7
更新日期:2010-11-01 00:00:00
abstract::Reaming increases intramedullary pressure and can cause fat intravasation. This study investigated the influence of reaming parameters on pressure changes using the AO, Gray, and Howmedica reamers. Silicone cylindrical shells with 10-, 11-, 16-, 19-, and 20-mm inner diameters were filled with a 1:2 ratio of paraffin a...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200004000-00036
更新日期:2000-04-01 00:00:00
abstract::Although the Chiari osteotomy is usually effective in reducing pain, many patients are left with a long-term limp. The postoperative limp can at times be caused by hip abductors that have strength insufficient to counteract the torque from body weight during single-leg stance. To study how the surgical technique affec...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-05-01 00:00:00
abstract::Only 1 well-documented case of osteochondroma in the posterior elements of the cervical spine has been previously reported. Although unusual, osteochondroma should be considered in the differential diagnosis of benign appearing tumors in the cervical spine. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-07-01 00:00:00
abstract::Most studies on shoulder arthroplasty include a diverse group of patients presenting to a tertiary care center. Little information is available regarding outcomes in a community setting. We reviewed 98 residents (110 shoulders) of Olmsted County, Minnesota who had shoulder arthroplasties from 1976 to 2000. There were ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000238870.99980.64
更新日期:2007-02-01 00:00:00
abstract::The dislocation rate of 3197 Charnley prostheses with 22 mm head in which the surgery was done between 1979 and 1991 in 2 orthopaedic centers was compared with that of 2875 Lubinus prostheses with 32 mm head in which the surgery was done between 1980 to 1991 in 3 other centers. A 1-year followup showed an equal rate o...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,多中心研究
doi:
更新日期:1996-12-01 00:00:00
abstract::Ectopic bone formation was associated with osteoid osteoma in the anterior rim of the acetabulum. A factor, which has been speculated to be secreted from the nidus and is responsible for increased osteoblastic activity, also seemed to have the capacity to stimulate young mesenchymal cells to differentiate into an oste...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1994-02-01 00:00:00
abstract::Although the physeal cartilage is considered resistant to invasion by metaphyseal osteosarcoma, no objective clinical proof exists to support this view. Fourteen cases of osteosarcoma of long bones in patients ranging in age from ten to 19 years with open physes were reviewed to determine the incidence of transphyseal...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-07-01 00:00:00
abstract::Spinal canal stenosis is diagnosed in a 45-year-old man who has osteopoikilosis and anomalies of the hip. Clinical investigations demonstrated a lumbar syndrome, previously described as an early phase of a neuropathic condition, namely, the premyelopathic syndrome. Roentgenographic calculations of canal diameters and ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-06-01 00:00:00