The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2014
Randomized Controlled Trial Comparative Study Pragmatic Clinical TrialTendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up.
There is limited Level-I evidence that compares operative and nonoperative treatment of rotator cuff tears. We compared outcomes of patients treated with primary tendon repair with outcomes of those treated with physiotherapy and optional secondary tendon repair if needed. ⋯ Although primary repair of small and medium-sized rotator cuff tears was associated with better outcome than physiotherapy treatment, the differences were small and may be below clinical importance. In the physiotherapy treatment group, there were increasing tear sizes and inferior outcomes in one-third of patients who did not undergo repair.
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J Bone Joint Surg Am · Sep 2014
Comparative StudyMorbid obesity: a significant risk factor for failure of two-stage revision total knee arthroplasty for infection.
Obese patients have a higher risk of complications following primary total knee arthroplasty, including periprosthetic joint infection. However, there is a paucity of data concerning the efficacy of two-stage revision arthroplasty in obese patients. ⋯ Morbid obesity significantly increased the risk of subsequent revision, reoperation, and reinfection following two-stage revision total knee arthroplasty for infection. In addition, these patients had worse pain relief and overall function at intermediate-term clinical follow-up. Although two-stage revision should remain a standard treatment for chronic periprosthetic joint infection in morbidly obese patients, increased failure rates and poorer outcomes should be anticipated.
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J Bone Joint Surg Am · Sep 2014
Comparative StudyUsage of recombinant human bone morphogenetic protein in cervical spine procedures: analysis of the MarketScan longitudinal database.
Usage of recombinant human bone morphogenetic protein (rhBMP) in anterior cervical discectomy and fusion (ACDF) procedures is controversial. Studies suggest increased rates of dysphagia, hematoma or seroma, and severe airway compromise in anterior cervical spine procedures using rhBMP. The purpose of the present study was to determine and describe national utilization trends and complication rates associated with rhBMP usage in anterior cervical spine procedures. ⋯ Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Sep 2014
Randomized Controlled Trial Comparative StudyThe influence of vitamin C on the outcome of distal radial fractures: a double-blind, randomized controlled trial.
Vitamin C has been proposed to improve outcomes after a distal radial fracture by promotion of bone and soft-tissue healing and reduction of the prevalence of complex regional pain syndrome (CRPS). Our primary aim was to examine the effect of vitamin C on functional outcome after a distal radial fracture. ⋯ Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Sep 2014
Multicenter Study Comparative StudyEffect of post-discharge venous thromboembolism on hospital quality comparisons following hip and knee arthroplasty.
Symptomatic pre-discharge venous thromboembolism (VTE) rates after total or partial hip or knee arthroplasty have been proposed as patient safety indicators. However, assessing only pre-discharge VTE rates may be suboptimal for quality measurement as the duration of stay is relatively short and the VTE risk extends beyond the inpatient setting. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.