The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Oct 2013
Clinical TrialPatient-reported outcomes after total knee replacement vary on the basis of preoperative coexisting disease in the lumbar spine and other nonoperatively treated joints: the need for a musculoskeletal comorbidity index.
Although the majority of patients report substantial gains in physical function following primary total knee replacement, the degree of improvement varies widely. To understand the potential role of preoperative pain due to other musculoskeletal conditions on postoperative outcomes, we quantified bilateral knee and hip pain and low back pain before primary total knee replacement and evaluated its association with physical function at six months after total knee replacement. ⋯ Preoperative musculoskeletal pain in the low back and nonoperatively treated lower extremity joints is associated with poorer physical function at six months after total knee replacement. The degree of functional improvement varies with the burden of musculoskeletal pain in other weight-bearing locations.
-
J Bone Joint Surg Am · Oct 2013
Comparative Study Clinical TrialComputerized adaptive testing of psychological factors: relation to upper-extremity disability.
Psychological factors are important mediators of the differences between impairment and disability. The most commonly used measures of disability and psychological factors are lengthy and are usually administered as paper questionnaires. The aim of this study was to assess the correlation between perceived disability and psychological factors with use of the user-friendly, web-based Patient Reported Outcomes Measurement Information System initiative, and to compare its correlation with a frequently used, paper-based, pain self-efficacy questionnaire. ⋯ Maladaptive responses to upper-extremity pain are accurately measured by the relatively user-friendly Patient Reported Outcomes Measurement Information System-based computerized adaptive testing questionnaire.
-
J Bone Joint Surg Am · Oct 2013
Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors.
There has been a major and alarming increase in readmission rates following total joint arthroplasty. With proposed changes in reimbursement policy, increased rates of unplanned readmission following arthroplasty will penalize providers. In particular, it has been proposed that specific complications--so-called "zero-tolerance" complications--are unacceptable and that their treatment will not qualify for reimbursement. The purpose of this study was to identify the incidence, causes, and risk factors for readmission following total joint arthroplasty. ⋯ The high incidence of readmissions secondary to potential "zero-tolerance" events suggests that these are not easily preventable complications. In addition, longer hospitalization and discharge to an inpatient continued-care facility increased the risk of readmission.
-
J Bone Joint Surg Am · Oct 2013
The biomechanical relevance of anterior rotator cuff cable tears in a cadaveric shoulder model.
Anterior tears of the supraspinatus tendon are more likely to be clinically relevant than posterior tears of the supraspinatus. We hypothesized that anterior tears of the supraspinatus tendon involving the rotator cuff cable insertion are associated with greater tear gapping, decreased tendon stiffness, and increased regional tendon strain under physiologic loading conditions compared with equivalently sized tears of the rotator cuff crescent. ⋯ Clinicians should consider early repair of rotator cuff cable tears, which may need surgical intervention to address their biomechanical pathology. In contrast, surgical treatment may be more safely delayed for rotator cuff crescent tears.
-
J Bone Joint Surg Am · Oct 2013
Orthopaedic fellowship selection criteria: a survey of fellowship directors.
The pursuit of a fellowship has become increasingly popular over the past several years, with >90% of graduating orthopaedic residents applying for a fellowship position. Despite the ample literature available pertaining to the selection of orthopaedic residents, there is no similar research for the selection of fellows. ⋯ The overall response rate was 193 (46.5%) of 415 orthopaedic fellowship program directors. The most important criteria in selecting an applicant for an interview were a letter of recommendation from subspecialty faculty (1.38 points), quality of residency program (2.02 points), and a letter of recommendation from the residency program director (2.12 points). The most important criteria in completing the rank order list following the interview were the interview (1.17 points), a letter of recommendation from subspecialty faculty (1.46 points), a letter of recommendation from the residency program director (2.16 points), and expressed interest in program (2.16 points).