The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 2014
Preoperative Opioid Use as a Predictor of Adverse Postoperative Self-Reported Outcomes in Patients Undergoing Spine Surgery.
Opioids are commonly used for preoperative pain management in patients undergoing spine surgery. The objective of this investigation was to assess whether preoperative opioid use predicts worse self-reported outcomes in patients undergoing spine surgery. ⋯ Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Jun 2014
Early Patient Outcomes After Primary Total Knee Arthroplasty with Quadriceps-Sparing Subvastus and Medial Parapatellar Techniques: A Randomized, Double-Blind Clinical Trial.
Techniques that reduce injury to the knee extensor mechanism may cause less pain and allow faster recovery of knee function after primary total knee arthroplasty. A quadriceps-sparing (QS) subvastus technique of total knee arthroplasty was compared with medial parapatellar arthrotomy (MPPA) to determine which surgical technique led to better patient-reported function and less postoperative pain and opioid utilization. METHODS: In this prospective, double-blind study, 129 patients undergoing total knee arthroplasty were randomized to the QS or the MPPA group after skin incision. ⋯ However, the mean pain scores reported by patients in the QS group were slightly lower at rest on postoperative day one and during activity on day three. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Jun 2014
The Role of Overweight and Obesity in Relation to the More Rapid Growth of Total Knee Arthroplasty Volume Compared with Total Hip Arthroplasty Volume.
The volume of primary joint replacements performed in the United States increased rapidly over the past twenty years, but the growth rate of total knee arthroplasties exceeded that of total hip arthroplasties. The aim of this study was to identify the key contributing factors behind this differential growth rate. ⋯ Growth in total knee arthroplasty volume has far outpaced that of total hip arthroplasty among those with a body mass index of ≥25 kg/m2 but not for those with a body mass index of <25 kg/m2. The magnitude of this effect will continue to expand if the proportion of Americans with a body mass index of ≥25 kg/m2 continues to increase. Changes in hospital and physician reimbursement, length of stay, and in-hospital mortality did not contribute to this differential growth rate.
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J Bone Joint Surg Am · May 2014
Autologous chondrocyte implantation in the knee: mid-term to long-term results.
From 1998 to 2008, 1000 skeletally mature patients underwent autologous chondrocyte implantation for an osteochondral defect of the knee. We evaluated the functional outcomes in 827 of 869 patients who had undergone autologous chondrocyte implantation with Chondron or periosteum (ACI-C/ACI-P) or matrix-assisted chondrocyte implantation (MACI) and attempted to identify factors that influenced outcome. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · May 2014
Randomized Controlled Trial Comparative StudyThe relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: a prospective randomized trial.
Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to determine the efficacy of intraoperative tranexamic acid, epsilon-aminocaproic acid, and placebo at reducing perioperative blood loss and the transfusion rate in patients with adolescent idiopathic scoliosis undergoing posterior spinal arthrodesis. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.