The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2014
Comparative StudyMedicaid payer status is associated with in-hospital morbidity and resource utilization following primary total joint arthroplasty.
Previous reports suggest that there are major disparities in outcomes following total joint arthroplasty among patients with different payer statuses. The explanation for these differences is largely unknown and may result from confounding variables. The Affordable Care Act expansion of Medicaid coverage in 2014 makes the examination of these disparities particularly relevant. ⋯ Compared with non-Medicaid patients, Medicaid patients have a significantly higher risk for certain postoperative in-hospital complications and consume more resources following total joint arthroplasty even when the two groups have been matched for patient-related factors and comorbid conditions commonly associated with low socioeconomic status. Additional work is needed to understand the complex interplay between socioeconomic status and outcomes, to ensure appropriate resources are allocated to maintain access for this patient population, and to develop appropriate risk stratification.
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J Bone Joint Surg Am · Nov 2014
Comparative StudyComparison of highly cross-linked and conventional polyethylene in posterior cruciate-substituting total knee arthroplasty in the same patients.
We are not aware of any information on in vivo clinical results at a minimum of five years after posterior cruciate-substituting total knee arthroplasties performed with a highly cross-linked polyethylene insert. The purpose of the study was to evaluate whether the clinical and radiographic results of posterior cruciate-substituting total knee prostheses, including the prevalences of fracture of the polyethylene post, failure of the locking mechanism of the tibial polyethylene insert, and osteolysis, would be similar between patients treated with conventional polyethylene and those treated with highly cross-linked polyethylene. ⋯ The data suggest that clinical and radiographic findings at five years after posterior cruciate-substituting total knee arthroplasty were the same for the patients treated with highly cross-linked polyethylene and those treated with conventional polyethylene.
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Blood transfusion after orthopaedic surgery accounts for 10% of all packed red blood-cell transfusions, but use varies substantially across hospitals and surgeons. Transfusions can cause systemic complications, including allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, graft-versus-host disease, and infections. ⋯ Current clinical evidence does not justify transfusions for a hemoglobin level of >8 g/dL in the absence of symptoms. Studies have also supported the use of this trigger in patients with a history or risk of cardiovascular disease.
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J Bone Joint Surg Am · Nov 2014
Risk-factor analysis of adjacent-segment pathology requiring surgery following anterior, posterior, fusion, and nonfusion cervical spine operations: survivorship analysis of 1358 patients.
Adjacent-segment pathology is an important issue involving the cervical spine, but there have been few comprehensive studies of this problem. The purpose of the current study was to determine the risk factors for adjacent-segment pathology and to compare the survivorship of adjacent segments in patients who underwent cervical spine operations including arthrodesis and motion-sparing procedures. ⋯ Patients treated with posterior or combined anterior and posterior arthrodesis were far more likely to develop clinical adjacent-segment pathology requiring surgery than those treated with posterior decompression or anterior arthrodesis. Smokers and women had a higher chance of clinical adjacent-segment pathology after cervical spine surgery.