The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialA minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial.
Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions. The orthopaedic literature is deficient in well-designed scientific studies to support the clinical superiority of this approach. The objective of this study was to compare the results of a single mini-incision approach with those of a standard-incision total hip arthroplasty in the early postoperative period. ⋯ Minimally invasive total hip arthroplasty performed through a single-incision posterior approach by a high-volume hip surgeon with extensive experience in less invasive approaches to the hip is safe and reproducible. However, it offers no significant benefit in the early postoperative period compared with a standard incision of 16 cm. As it is not known whether lower-volume and less-experienced surgeons can achieve similar results, the mini-incision technique merits further study before wide dissemination and implementation of this family of surgical approaches can be recommended.
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J Bone Joint Surg Am · Apr 2005
Clinical Trial Controlled Clinical TrialTranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty.
Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin, has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip arthroplasty with cement. However, there have been few reports describing the effects of tranexamic acid on blood loss during and following total hip arthroplasty without cement. ⋯ In patients undergoing total hip arthroplasty without cement, preoperative administration of tranexamic acid is associated with decreased postoperative blood loss during the first twenty-four hours, especially during the first four hours after surgery.
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J Bone Joint Surg Am · Apr 2005
Comparative StudyThe early effects of code 405 work rules on attitudes of orthopaedic residents and attending surgeons.
The impact of strict enforcement of Section 405 of the New York State Public Health Code to restrict resident work to eighty hours per week and the adoption of a similar policy by the Accreditation Council on Graduate Medical Education in 2002 for orthopaedic residency training have not been evaluated. Adoption of these rules has created accreditation as well as staffing problems and has generated controversy in the surgical training community. The purposes of this study were (1) to evaluate the attitudes of orthopaedic residents and attending surgeons toward the Code 405 work-hour regulations and the effect of those regulations on the perceived quality of residency training, quality of life, and patient care and (2) to quantify the effect of the work-hour restrictions on the actual number of hours worked. ⋯ On the basis of the survey data, the implementation of the new work-hour restrictions was found to result in a decrease in the number of hours worked per week for PGY-2 and PGY-3 residents and in an increase in work hours for PGY-4 residents. This could explain the definite difference between the attitudes expressed by the senior residents and those of the junior residents. Senior residents felt that their education was negatively impacted by the work rules, while junior residents expressed a more neutral view. However, senior residents did not believe that their operative experience was as negatively impacted as did junior residents. Although junior and senior residents and attending surgeons agreed that resident quality of life had improved, we were not able to determine whether this offset the perceived negative impact on education, continuity of care, and operative experience.
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J Bone Joint Surg Am · Apr 2005
Cross-cultural adaptation and validation of the Brazilian Portuguese version of the short musculoskeletal function assessment questionnaire: the SMFA-BR.
This study was designed to translate, culturally adapt, and validate a Brazilian Portuguese version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-BR). ⋯ A reliable and valid Brazilian Portuguese version of the SMFA was developed. It will facilitate the examination of functional performance within a large patient population as well as allow cross-cultural comparisons.
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J Bone Joint Surg Am · Apr 2005
A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions.
It has been speculated that a shift of the throwing arc commonly develops in athletes who perform overhead activities, resulting in greater external rotation and decreased internal rotation caused by anterior capsular laxity and posterior capsular contracture, respectively. Osseous adaptation in the form of increased humeral and glenoid retroversion may provide a protective function in the asymptomatic athlete but cannot explain the pathological changes seen in the shoulder of the throwing athlete. Therefore, the objective of the present study was to examine the biomechanical effects of capsular changes in a cadaveric model. ⋯ A posterior capsular contracture with decreased internal rotation does not allow the humerus to externally rotate into its normal posteroinferior position in the cocking phase of throwing. Instead, the humeral head is forced posterosuperiorly, which may explain the etiology of Type-II superior labrum anterior-to-posterior lesions in overhead athletes.