A review of the clinical approach to persistent pain following total hip replacement

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Controlling single-photon transport with three-level quantum dots in photonic crystals

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Total knee arthroplasty for primary knee osteoarthritis: Changing pattern over the past 10 years

Objective: To review the epidemiology of total knee arthroplasty for primary osteoarthritis and the change of patient characteristics over the last decade. Design: Retrospective review. Setting: A tertiary referral centre for joint replacement surgery in a teaching hospital in Hong Kong. Patients: All patients who underwent primary total knee arthroplasty for primary knee osteoarthritis from January 2000 to December 2009. Results: In all, 1157 total knee arthroplasties (589 left and 568 right) were performed on 588 females and 162 males. The annual number of total knee arthroplasties increased from 91 in 2000 to 181 in 2009. The annual number of patients increased from 58 (46 female, 12 male) in 2000 to 159 (117 female, 42 male) in 2009. When compared yearly results, there were no significant changes in the preoperative Knee Society Knee Score, Knee Society Functional Assessment, and passive range of motion of these patients. However, there was a significant decreasing trend with regard to lower limb mechanical axis mal-alignment, from 15.1° deviation from the neutral axis in 2000, to 14.8° deviation in 2004, and then 12.9° deviation in 2009 (mostly varus deformity). There was no difference between left knees and right knees, and between females and males. The mean age of the patients did not show significant change over the past decade, but the number and proportion of patients over 80 years old showed an increase from 4.8% (2000 to 2004) to 13.8% (2005 to 2009). On the other hand, the number and proportion of patients under the age of 60 years did not change. Conclusions: There was an increasing trend towards total knee arthroplasties, both in terms of number of operations and patients. The number of younger patients having total knee arthroplasty did not increase over the last 10 years, whereas the number of those older than 80 years increased significantly over that period.published_or_final_versio

Review Article: Osteophytes

An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor β plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.published_or_final_versio

Why do Hong Kong patients need total hip arthroplasty? An analysis of 512 hips from 1998 to 2010

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Antibiotic prophylaxis after total joint replacements

Objectives: To review the latest evidence on antibiotic prophylaxis for patients with total joint replacements to prevent prosthesis infections. Data sources: Literature search of Medline and PubMed until June 2009. Study selection: Studies of patients with total joint replacements from around the world, studies concerning antibiotic prophylaxis, as well as chemoprophylaxis guidelines from orthopaedic associations were searched. Data extraction: Literature review, original articles, case reports, best practice guidelines. Data synthesis: With the rising incidence of patients with total joint replacements, subsequent deep infection of the implants is a rare but dreaded complication which has immense physiological, psychological, financial, and social implications. Guidelines from urologists, gastroenterologists, and dental surgeons attempt to identify high-risk patients who may be more susceptible to prosthetic joint infections. These patients are provided with prophylactic antibiotics before any invasive procedure that may cause bacterial seeding to prosthetic joints. Most orthopaedic associations around the world adopt a similar policy to provide prophylaxis to cover any anticipated chance of bacteraemia. The American Association of Orthopaedic Surgeons adopts the most cautious approach in which all patients with total joint replacements who undergo any procedure that breaches a mucosal surface receive prophylactic antibiotics. Conclusion: The guidelines from the American Association of Orthopaedic Surgeons seem to have an all-encompassing policy when it comes to providing prophylactic antibiotics. Nonetheless, physicians must still exercise their judgement and customise the treatment to each patient. The benefits of prophylactic antibiotics must be balanced against the risks of drug side-effects and the emergence of antibiotic resistance.published_or_final_versio

On the elliptical flow in asymmetric collisions and nuclear equation of state

We here present the results of elliptical flow for the collision of different asymmetric nuclei (10Ne20 +13 Al27, 18Ar40 +21 Sc45, 30Zn64 +28 Ni58, 36Kr86 +41 Nb93) by using the Quantum Molecular Dynamics (QMD) model. General features of elliptical flow are investigated with the help of theoretical simulations. The simulations are performed at different beam energies between 40 and 105 MeV/nucleon. A significant change can be seen from in-plane to out-of-plane elliptical flow of different fragments with incident energy. A comparison with experimental data is also made. Further, we predict, for the first time that, elliptical flow for different kind of fragments follow power law dependence ? C(Atot)? for asymmetric systems

Perioperative antithrombotic management in joint replacement surgeries

Objectives To determine optimal perioperative antithrombotic management for patients with cardiac diseases undergoing joint replacement surgeries. Data sources MEDLINE and PubMed database search up to January 2013. Study selection Those dealing with perioperative antithrombotic management of patients undergoing orthopaedic operations, especially joint replacement, and also those undergoing general surgery. Various combinations of the following key words were used in our search: 'antiplatelet', 'antithrombotic', 'anticoagulant', 'coronary stent', 'perioperative', 'venous thromboembolism', 'cardiovascular', 'surgery', 'orthopaedic', 'knee replacement', 'hip replacement', 'joint replacement', and 'arthroplasty'. Data extraction Literature review, original articles, and best practice guidelines. Data synthesis Patients should be stratified according to their risk of developing arterial thromboembolism in order to decide the most appropriate perioperative antiplatelet or anticoagulant regimen for them. After recent coronary stenting, including bare-metal stents implanted within 6 weeks and drug-eluting stents implanted within 6 months, surgery should be deferred. For venous thromboembolism prophylaxis in patients already on aspirin, the dosage should be adjusted as necessary or additional low-molecular-weight heparin administered. Conclusion The perioperative management of patients with cardiac diseases in receipt of antithrombotic agents is based upon a delicate balance between the perceived risk of arterial thromboembolism and the perceived risk of perioperative bleeding. One must exercise good judgement in deciding the most appropriate perioperative antithrombotic regimen. Venous thromboembolism is also a common problem after joint replacement surgeries. For patients already on aspirin, optimal venous thromboembolism prophylaxis is still being debated.published_or_final_versio

Restoration of Humeral Bone Stock Two Years After Internal Fixation of a Periprosthetic Fracture with a Loose Stem

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Temperature dependence of Vortex Charges in High Temperature Superconductors

Using a model Hamiltonian with d-wave superconductivity and competing antiferromagnetic (AF) interactions, the temperature (T) dependence of the vortex charge in high T_c superconductors is investigated by numerically solving the Bogoliubov-de Gennes equations. The strength of the induced AF order inside the vortex core is T dependent. The vortex charge could be negative when the AF order with sufficient strength is present at low temperatures. At higher temperatures, the AF order may be completely suppressed and the vortex charge becomes positive. A first order like transition in the T dependent vortex charge is seen near the critical temperature T_{AF}. For underdoped sample, the spatial profiles of the induced spin-density wave and charge-density wave orders could have stripe like structures at T < T_s, and change to two-dimensional isotropic ones at T > T_s. As a result, a vortex charge discontinuity occurs at T_s.Comment: 5 pages, 5 figure