The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2015
Comparative StudyGeneral compared with spinal anesthesia for total hip arthroplasty.
Total hip arthroplasty may be performed under general or spinal anesthesia. The purpose of the current study was to compare perioperative outcomes between anesthetic types for patients undergoing primary elective total hip arthroplasty. ⋯ General anesthesia was associated with an increased rate of adverse events and mildly increased operating room times.
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J Bone Joint Surg Am · Mar 2015
Randomized Controlled Trial Comparative StudyPain control after simultaneous bilateral total knee arthroplasty: a randomized controlled trial comparing periarticular injection and epidural analgesia.
Periarticular injection is becoming more commonly utilized for pain relief following total knee arthroplasty. However, we are aware of no randomized controlled trial that has investigated the efficacy of periarticular injection for pain relief after simultaneous bilateral total knee arthroplasty. ⋯ Periarticular injection was associated with better pain relief during the first twenty-four hours following simultaneous bilateral total knee arthroplasty and decreased opioid-related side effects compared with epidural analgesia. Periarticular injection may be preferable to epidural analgesia for pain relief after simultaneous bilateral total knee arthroplasty.
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J Bone Joint Surg Am · Mar 2015
Impact of fellowship training on clinical practice of orthopaedic sports medicine.
Approximately 90% of current orthopaedic graduates are engaging in fellowship training, with sports medicine being the most commonly chosen specialty. The purpose of this study was to evaluate the impact of fellowship training on clinical decision-making by fellowship-trained sports medicine surgeons. ⋯ Fellowship has a significantly higher impact than residency on industry-related decision-making. Fellowship-trained sports surgeons should consider seeking additional training in the treatment of multi-ligamentous knee injuries, posterior cruciate ligament injuries, shoulder instability with bone loss, and elbow disorders. The current findings were limited by the relatively small respondent pool, which represented only 26% of sports medicine fellowship programs in the United States.
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J Bone Joint Surg Am · Feb 2015
Comparative StudyThe impact of trauma-center care on mortality and function following pelvic ring and acetabular injuries.
Lower mortality and improved physical function following major polytrauma have been associated with treatment at level-I trauma centers compared with that at hospitals without a trauma center (nontrauma centers). This study investigated the impact of trauma-center care on outcomes after pelvic and acetabular injuries. ⋯ Mortality was reduced for patients with unstable pelvic and severe acetabular injuries when care was provided in a trauma center compared with a nontrauma center. Moreover, those with severe acetabular fractures experienced improved physical function at one year. Patients with these injuries represent a well-defined subset of trauma patients for whom our findings suggest preferential triage or transfer to a level-I trauma center.