The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2000
Comparative StudyLong-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation.
Low-back problems are one of the most frequent reasons for disability compensation claims by workers. However, the effect of Workers' Compensation status on the long-term outcome for workers with sciatica has not been studied in detail, to our knowledge. Therefore, we believe that it is important to describe the long-term outcomes for patients who have herniation of a lumbar disc and sciatica according to the Workers' Compensation status at the time of the preoperative consultation. ⋯ Even after adjustment for the initial treatment of the sciatica and for other clinical factors, patients who had been receiving Workers' Compensation at baseline were more likely to be receiving disability benefits and were less likely to report relief from symptoms and improvement in quality of life at the time of the four-year follow-up than patients who had not been receiving Workers' Compensation at baseline. Nonetheless, most patients returned to work regardless of their initial disability status, and those who had been receiving Workers' Compensation at baseline were only slightly less likely to be working after four years. Whether or not they had been receiving Workers' Compensation at baseline, patients who had been managed with an operation reported greater relief from symptoms and improvement in functional status at the time of the four-year follow-up compared with patients who had been managed nonoperatively, even though the outcomes with regard to disability and work status in these two groups were comparable.
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J Bone Joint Surg Am · Jan 2000
Randomized Controlled Trial Clinical TrialShoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis.
The indications for resurfacing of the glenoid in patients who have osteoarthritis of the shoulder are not clearly defined; some investigators routinely perform hemiarthroplasty whereas others perform total shoulder arthroplasty. ⋯ Total shoulder arthroplasty provided superior pain relief compared with hemiarthroplasty in patients who had glenohumeral osteoarthritis, but it was associated with an increased cost of $1177 per patient.
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J Bone Joint Surg Am · Jan 2000
Preoperative autologous donation for total joint arthroplasty. An analysis of risk factors for allogenic transfusion.
While autologous blood is commonly predonated to provide replacement of blood lost in orthopaedic procedures, few studies of patients managed with total joint replacement have addressed the problem of which patients are likely to benefit from an autologous blood-donation program. ⋯ The efficiency of collection of autologous blood can be improved by identifying patients who have a very low risk of transfusion according to the type of arthroplasty, the initial level of hemoglobin, and age. Patients who have an initial hemoglobin level of at least 150 grams per liter or an initial hemoglobin level of between 130 and 150 grams per liter and an age of less than sixty-five years have a minimal risk of needing a transfusion during or after a primary total joint replacement. These patients should be apprised of their low risk so that they can make an informed decision regarding preoperative autologous donation.