The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2014
Comparative StudyComparative effectiveness of ceramic-on-ceramic implants in stemmed hip replacement: a multinational study of six national and regional registries.
The rapid decline in use of conventional total hip replacement with a large femoral head size and a metal-on-metal bearing surface might lead to increased popularity of ceramic-on-ceramic bearings as another hard-on-hard alternative that allows implantation of a larger head. We sought to address comparative effectiveness of ceramic-on-ceramic and metal-on-HXLPE (highly cross-linked polyethylene) implants by utilizing the distributed health data network of the ICOR (International Consortium of Orthopaedic Registries), an unprecedented collaboration of national and regional registries and the U.S. FDA (Food and Drug Administration). ⋯ Our multinational study based on a harmonized, distributed network showed that use of ceramic-on-ceramic implants with a smaller head size in total hip arthroplasty without cement was associated with a higher risk of revision compared with metal-on-HXLPE and >28-mm ceramic-on-ceramic implants. These findings warrant careful reflection by regulatory and clinical communities and wide dissemination to patients for informed decision-making regarding such surgery.
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J Bone Joint Surg Am · Dec 2014
Surgical site infections after posterior spinal fusion for neuromuscular scoliosis: a thirty-year experience at a single institution.
Surgical site infection is a serious complication of posterior spinal fusion for neuromuscular scoliosis, with a reported prevalence of 6% to 24%. A single-institution experience over a thirty-year period was reviewed to determine the prevalence of surgical site infection after posterior spinal fusion for neuromuscular scoliosis, and to identify patient and treatment-related risk factors. ⋯ This study identified modifiable factors, especially antibiotic dosing and drain use, associated with surgical site infection in patients with neuromuscular scoliosis.
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J Bone Joint Surg Am · Dec 2014
Randomized Controlled Trial Comparative StudyTopical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial.
Abundant literature regarding the use of intravenous tranexamic acid (TXA) in primary total knee replacement is available. Randomized controlled trials have confirmed the efficacy of topical TXA compared with placebo, but the comparison between topical and intravenous TXA is unclear. The present study was designed to verify noninferior efficacy and safety of topical intra-articular TXA compared with intravenous TXA in primary total knee replacement with cemented implants. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Dec 2014
Comparative StudyVariations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures.
There has been an increasing use of national databases to conduct orthopaedic research. Questions regarding the validity and consistency of these studies have not been fully addressed. The purpose of this study was to test for similarity in reported measures between two national databases commonly used for orthopaedic research. ⋯ As database studies become more prevalent in orthopaedic surgery, authors, reviewers, and readers should view these studies with caution. This study shows that two commonly used databases can identify demographically similar patients undergoing a common orthopaedic procedure; however, the databases document markedly different rates of comorbidities and inpatient adverse events. The differences are likely the result of the very different mechanisms through which the databases collect their comorbidity and adverse event data. Findings highlight concerns regarding the validity of orthopaedic database research.