Consensus Statement From the Consensus Conference on Bilateral Total Knee Arthroplasty Group.
Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group.
Clin Orthop Relat Res. 2013 Apr 6;
Memtsoudis SG, Hargett M, Russell LA, Parvizi J, Cats-Baril WL, Stundner O, Sculco TP,
BACKGROUND: Controversy exists regarding many aspects of decision making pertaining to same-day versus staged bilateral TKA (BTKAs), including patient selection, perioperative management decisions, and other important choices. QUESTIONS/PURPOSES : In the absence of suitable randomized trials, we sought to determine areas of consensus among national experts on the following questions: (1) What are the comparative risks of same-day BTKAs compared with unilateral TKA (UTKA) and staged BTKAs? (2) Who should be considered an appropriate candidate for same-day BTKAs? (3) What constitutes appropriate workup and perioperative management for BTKAs? (4) What is the optimal time between procedures if same-day BTKAs are not deemed appropriate? (5) Are there orthopaedic or rehabilitation considerations for BTKAs that might outweigh medical contraindications? METHODS : In the setting of a consensus conference of national experts in orthopaedic surgery, anesthesiology, perioperative medicine, and epidemiology, the major questions surrounding same-day BTKAs were addressed by using an extensive literature review and the modified Delphi process. The process concluded with a meeting of participants and formulation of consensus statements. RESULTS: Eighty-one percent of participants agreed that BTKAs are more invasive and complex procedures associated with increased risk for perioperative adverse events compared with UTKA in an unselected group of patients. The consensus group agreed that physicians and hospitals should consider using more restrictive patient selection criteria and exclude those with a modified cardiac risk index greater than 3 to mitigate the potentially increased risk. The majority of the group agreed that perioperative assessment and management should reflect the higher level of acuity of same-day BTKAs. Eighty-one percent of participants agreed that if a patient is not deemed a candidate for same-day BTKAs, a second TKA should be scheduled no sooner than 3 months after the first. The entire group agreed that when there is a conflict between the orthopaedic need and the medical adequacy of same-day BTKAs, the medical concern for the patient’s safety should prevail over the orthopaedic need. CONCLUSIONS : Experts perceived that same-day BTKAs increase medical risk, and thus a systematic approach to the management of patients should be taken to minimize complications. HubMed – rehab
Dynamic Rehabilitation of Facial Nerve Injury: A Review of the Literature.
J Reconstr Microsurg. 2013 Apr 5;
Rabie AN, Ibrahim AM, Kim PS, Medina M, Upton J, Lee BT, Lin SJ
Introduction Given the morbidity caused by facial nerve paralysis, there have been consistent approaches to treatment over the past 20 years in reanimation of the facial nerve. Treatment depends on accurate clinical examination, a good understanding of the anatomic course, and appropriate diagnostic tests. There are various options when it comes to dynamic facial nerve reanimation that range from nerve grafting, nerve anastomosis, crossover techniques and muscle transfer to microneurovascular muscle flaps, and-recently-potentially new concepts with microelectromechanical systems (MEMS) technology. The various dynamic facial nerve treatment modalities are discussed. Methods and Results A comprehensive review of the literature was performed detailing various techniques used for dynamic rehabilitation following facial nerve injury and their known results and complications. Conclusions Currently, techniques have been attempted to achieve adequate dynamic facial reanimation of the paralyzed facial nerve. Despite the advances that have occurred in the last few years, it has been classically very difficult to achieve a House-Brackmann grade better than grade III. Outcomes are improving. Ultimately, the approach depends on the surgeon’s experience. HubMed – rehab
Learning from the Vikings: Havamal and occupational rehabilitation.
Occup Med (Lond). 2013 Apr; 63(3): 230
O’Neill D