The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2007
Intraoperative red blood-cell salvage in revision hip surgery. A case-matched study.
Revision hip arthroplasty is commonly associated with substantial blood loss and the subsequent need for transfusion. This leads to an increased risk of blood-borne infection and hemolytic reactions. The purpose of this study was to demonstrate whether the use of intraoperative red blood-cell salvage in revision hip arthroplasty reduces the overall rate of allogeneic transfusion. ⋯ The use of intraoperative cell salvage significantly lowered the allogeneic transfusion requirement, which can lead to substantial cost savings. To our knowledge, this is the first study in which the use of intraoperative red blood-cell salvage in revision hip arthroplasty was evaluated by matching patients on the basis of age, sex, and operative variables.
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Following total knee arthroplasty, some patients who fail to achieve >90 degrees of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total knee arthroplasty. ⋯ Manipulation generally increases ultimate flexion following total knee arthroplasty. Patients with severe preoperative pain are more likely to require manipulation.
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J Bone Joint Surg Am · Feb 2007
Review Meta Analysis Comparative StudyArthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature.
Both arthroscopic and open surgical repairs are utilized for the management of anterior glenohumeral instability. To determine the evidence supporting the relative effectiveness of these two approaches, we conducted a rigorous and comprehensive analysis of all reports comparing arthroscopic and open repairs. ⋯ The available evidence indicates that arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling patients to return to work. Arthroscopic approaches resulted in better function as reflected by the Rowe scores in the randomized clinical trials. The study design and the arthroscopic technique had substantial effects on the results of the analysis.
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J Bone Joint Surg Am · Feb 2007
Comparative StudyElectromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back pain, and no back symptoms.
Magnetic resonance imaging is commonly used to diagnose lumbar spinal stenosis. Some persons without symptoms have a small lumbar spinal canal. Electrodiagnosis has been used to diagnose spinal stenosis for over sixty years, but we are aware of no masked, controlled trials of the use of electrodiagnosis for that purpose. This study was performed to evaluate the relationships of magnetic resonance imaging measures and electrodiagnostic data with the clinical syndrome of spinal stenosis. ⋯ This prospective, controlled, masked study of electrodiagnosis and magnetic resonance imaging for older subjects showed that imaging does not differentiate symptomatic from asymptomatic persons, whereas electrodiagnosis does. We believe that radiographic findings alone are insufficient to justify treatment for spinal stenosis.
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J Bone Joint Surg Am · Feb 2007
Antibiotic dosing before primary hip and knee replacement as a pay-for-performance measure.
There is a trend toward linking the reimbursement for health care services to clinical outcome. One such pay-for-performance proposal that affects orthopaedic surgeons is linking reimbursement for hip and knee replacements to measures such as the percentage of patients receiving antibiotics before surgery. We analyzed the risk factors associated with failing to optimally administer preoperative antibiotics before primary hip and knee arthroplasty. ⋯ Approximately 13% of the patients did not receive optimal antibiotic therapy before total hip and knee replacement. Surgeons can improve their performance score for this measure by focusing antibiotic strategies on patients receiving a hip replacement and on complex cases, by developing systems for antibiotic dosing with the anesthesia team, and by improving documentation.