The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2010
ReviewTwenty years of meta-analyses in orthopaedic surgery: has quality kept up with quantity?
As the number of studies in the literature is increasing, orthopaedic surgeons highly depend on meta-analyses as their primary source of scientific evidence. The objectives of this review were to assess the scientific quality and number of published meta-analyses on orthopaedics-related topics over time. ⋯ Although the methodological quality of orthopaedic meta-analyses has increased in the past twenty years, a substantial proportion continues to show major to extensive flaws. As the number of published meta-analyses is increasing, a routine checklist for scientific quality should be used in the peer-review process to ensure methodological standards for publication.
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J Bone Joint Surg Am · Jan 2010
Comparative StudyCognition following computer-assisted total knee arthroplasty: a prospective cohort study.
A substantial number of patients experience postoperative cognitive changes following total joint arthroplasty. The change in mental status may be the result of fat and bone-marrow-debris embolization. We hypothesized that the use of computer-assisted total knee arthroplasty, which does not involve the use of intramedullary alignment rods, would produce less fat and bone-marrow-debris embolization and, hence, fewer changes in mental status. ⋯ Further research is needed to determine if fat and bone-marrow-debris embolization is truly decreased by the use of computer-assisted total knee arthroplasty and if such a reduction has any clinical relevance.
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J Bone Joint Surg Am · Jan 2010
Clinical TrialPredictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixation.
The fulcrum bending radiograph accurately predicts scoliosis curve correction in patients with thoracic adolescent idiopathic scoliosis who are managed with hooks. We assessed the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation of the scoliotic spine. ⋯ To our knowledge, this is the first study to demonstrate the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation in patients with adolescent idiopathic scoliosis. Curve flexibility may dictate the degree of the fulcrum bending correction index, whereby a curve that is less flexible may achieve a greater fulcrum bending correction index. The fulcrum bending radiograph has potential predictive utility. In addition, pedicle screw constructs appear to have a better ability to correct scoliosis in comparison with hooks and hybrid constructs.
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J Bone Joint Surg Am · Jan 2010
The value of serum procalcitonin level for differentiation of infectious from noninfectious causes of fever after orthopaedic surgery.
Early diagnosis of postoperative orthopaedic infections is important in order to rapidly initiate adequate antimicrobial therapy. There are currently no reliable diagnostic markers to differentiate infectious from noninfectious causes of postoperative fever. We investigated the value of the serum procalcitonin level in febrile patients after orthopaedic surgery. ⋯ Serum procalcitonin is a helpful diagnostic marker supporting clinical and microbiological findings for more reliable differentiation of infectious from noninfectious causes of fever after orthopaedic surgery.
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J Bone Joint Surg Am · Jan 2010
Risk factors for spinal cord injury during surgery for spinal deformity.
Spinal cord monitoring is now considered standard care during surgery for spinal deformity. Combined somatosensory and motor evoked potential monitoring allows the detection of early spinal cord dysfunction in most patients. The purpose of the current study was to identify clinical factors that increase the risk of intraoperative electrophysical changes and to provide management recommendations. ⋯ Combined somatosensory and motor evoked potential monitoring effectively prevents neurologic injury in most children undergoing surgery for spinal deformity. Despite the potential for false-positive results, we recommend setting a low threshold for defining relevant electrophysical changes. Rapid intervention can reverse these changes and avoid potentially serious neurologic complications. Patients with cardiopulmonary comorbidities may be at a higher risk for having relevant electrophysical events.