The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Aug 2012
Compliance with Surgical Care Improvement Project measures and hospital-associated infections following hip arthroplasty.
Hospital compliance with the Surgical Care Improvement Project (SCIP) measures has increased recently for patients undergoing hip arthroplasty. However, reductions in postoperative infections were less than expected, and concern remains about complications associated with prophylaxis against venous thromboembolism (VTE). We sought to examine the association between hospital adherence to SCIP measures and postoperative infections. ⋯ Targeting complete compliance with SCIP infection prevention measures was not associated with additional reductions in infection outcomes following hip replacement. Furthermore, significant risk of postoperative infections may result from increased perioperative use of VTE prophylactics.
-
J Bone Joint Surg Am · Aug 2012
Randomized Controlled Trial Multicenter Study Comparative StudyThe impact of epidural steroid injections on the outcomes of patients treated for lumbar disc herniation: a subgroup analysis of the SPORT trial.
The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of operative versus nonoperative treatment of lumbar intervertebral disc herniation. It has been suggested that epidural steroid injections may help improve patient outcomes and lower the rate of crossover to surgical treatment. ⋯ Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection. There was a higher prevalence of crossover to nonsurgical treatment among surgically assigned ESI-group patients, although this was confounded by the increased baseline desire to avoid surgery among patients in the ESI group. Given these data, we concluded that more studies are necessary to establish the value of epidural steroid injection for symptomatic lumbar intervertebral disc herniation.
-
J Bone Joint Surg Am · Aug 2012
Comparative StudyHigh-flexion total knee arthroplasty: survivorship and prevalence of osteolysis: results after a minimum of ten years of follow-up.
We are aware of no information about the mid-term performance of the high-flexion total knee arthroplasty, although early results have been reported. The purpose of this study was to evaluate the mid-term results of high-flexion and conventional knee prostheses. ⋯ After a minimum duration of follow-up of ten years, there were no significant differences between the two groups with regard to implant survivorship, functional outcome, knee motion, or prevalence of osteolysis.
-
J Bone Joint Surg Am · Aug 2012
Levels of evidence in foot and ankle surgery literature: progress from 2000 to 2010?
The focus on evidence-based medicine has led to calls for increased levels of evidence in surgical journals. The purpose of the present study was to review the levels of evidence in articles published in the foot and ankle literature and to assess changes in the level of evidence over a decade. ⋯ There has been a trend toward higher levels of evidence in foot and ankle surgery literature over a decade, but the differences did not reach significance.
-
J Bone Joint Surg Am · Aug 2012
Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries.
Acute unstable syndesmotic ankle injuries are treated primarily by reduction and stabilization with a syndesmotic screw. Examination with fluoroscopy or standard radiographs may not provide reliable information about the quality of the reduction. There is evidence that intraoperative three-dimensional imaging can demonstrate a large proportion of malreductions. The aim of this study was to determine whether intraoperative three-dimensional imaging improves the detection of inadequate positioning of the distal aspect of the fibula in the tibiofibular incisura after syndesmotic screw insertion compared with the findings on standard intraoperative fluoroscopy. ⋯ Following open reduction and internal fixation of an ankle fracture, the correct position of the syndesmosis cannot be evaluated reliably with use of conventional radiographs or intraoperative fluoroscopy. In view of the high proportion of positive findings in this study, we believe that any treatment of a syndesmotic injury should include intraoperative three-dimensional imaging or at least a postoperative computed tomography scan.