The Journal of bone and joint surgery. American volume
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The Centers for Medicare & Medicaid Services (CMS) Open Payments public database, resulting from the Physician Payments Sunshine Act of 2010, was designed to increase transparency of physicians' financial relationships with pharmaceutical manufacturers. We compared physician-reported conflict-of-interest (COI) disclosures in journal articles with this database to determine any discrepancies in physician-reported disclosures. ⋯ COI disclosures are important for the interpretation of study results and need to be accurately reported. However, COI disclosure criteria vary among orthopaedic journals, causing uncertainty regarding which conflicts should be disclosed.
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J Bone Joint Surg Am · May 2019
Mandatory Prescription Limits and Opioid Utilization Following Orthopaedic Surgery.
Since 2016, over half of the states in the United States have passed mandatory limits on opioid prescriptions, with limited evidence of effectiveness. In this study, we evaluated postoperative opioid prescriptions following orthopaedic surgery before and after the implementation of one of the earliest such laws. ⋯ After implementation of mandatory opioid prescription regulations, a clinically important and significant decline in the volume of opioids dispensed in the short term and intermediate term following orthopaedic surgery was observed. Furthermore, important clinical predictors of prolonged postoperative opioid use, including preoperative opioid use and preoperative benzodiazepine use, were identified. These findings have important implications for public health, as well as the potential to influence policymakers and to change practice among orthopaedic surgeons.
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J Bone Joint Surg Am · May 2019
Randomized Controlled TrialAddition of Adductor Canal Block to Periarticular Injection for Total Knee Replacement: A Randomized Trial.
Periarticular injection is a popular method to control postoperative pain after total knee replacement. An adductor canal block is a sensory block that can also help to alleviate pain after total knee replacement. We hypothesized that the combination of adductor canal block and periarticular injection would allow patients to reach discharge criteria 0.5 day faster than with periarticular injection alone. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · May 2019
Multicenter StudyImplant Fracture Analysis of the TFNA Proximal Femoral Nail.
Mechanical failure of intramedullary nails is rare. This investigation was prompted by a series of cases of observed breakage of the recently introduced TFNA Proximal Femoral Nailing System (TFN [Trochanteric Fixation Nail]-Advanced; DePuy Synthes) in our region. Laboratory analysis and case data are presented, in contribution to post-market surveillance. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Apr 2019
Randomized Controlled Trial Comparative StudyPedaling-Based Protocol Superior to a 10-Exercise, Non-Pedaling Protocol for Postoperative Rehabilitation After Total Knee Replacement: A Randomized Controlled Trial.
Despite the routine use of physical therapy in the immediate and early postoperative phase for patients who undergo total knee replacement (TKR), there is a paucity of research into the optimal exercise protocols in both the acute inpatient setting and early period after discharge. Pedaling has often been recommended by clinicians after TKR for rehabilitation, but to our knowledge, there has been no investigation into its utility in the acute postoperative setting. Therefore, we performed a randomized controlled trial evaluating the efficacy of pedaling in the acute postoperative period. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.