Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialTwo-dose epoetin alfa reduces blood transfusions compared with autologous donation.
This study evaluated whether patients receiving a two-dose regime of epoetin alfa received less allogeneic blood than patients donating autologous blood before primary hip arthroplasty. Consenting patients with a hemoglobin level between 12 and 15 g/dL were randomly assigned to a two-dose administration of epoetin alfa (19 patients) or autologous donation (21 patients). ⋯ Hemoglobin remained significantly higher in the epoetin alfa group for 3 days after surgery. Administration of two doses of epoetin alfa provided patients with effective and safe reduction of allogeneic blood transfusions and decreased the necessity and difficulty of autologous donation before total hip arthroplasty.
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Clin. Orthop. Relat. Res. · Jun 2004
Incongruity versus instability in the etiology of posttraumatic arthritis.
The etiology of posttraumatic arthritis is understood poorly but it clearly has a pathomechanical component. Posttraumatic arthritis likely results from irreversible cartilage damage sustained at the time of injury and chronic cartilage overloading resulting from articular incongruity and instability. However, the relative importance of instability and incongruity is unknown. ⋯ We review the clinical and basic scientific evidence linking incongruity and instability to posttraumatic arthritis. Preliminary data from a newly developed dynamic ankle testing device are presented. Dynamic testing allows measurement of transient contact loads and loading rates that occur through the entire motion cycle and it opens the door to measure mechanical abnormalities associated with instability.
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Clin. Orthop. Relat. Res. · Jun 2004
Interrater reliability in grading abstracts for the orthopaedic trauma association.
Only a small proportion of submitted abstracts to the annual meeting of the Orthopaedic Trauma Association can be accepted for podium presentation. Annual program committee members must ensure that the selection of abstracts is free from bias and transparent to investigators. The objectives of this study are to examine the consistency of reviewers in grading abstracts submitted for podium presentations at the 2001 and 2002 Annual Meetings of the Orthopaedic Trauma Association and to evaluate whether the grades of the actual podium presentations at the meeting are consistent with the grades based on abstracts only. ⋯ Agreement among unblinded reviewers of the 67 and 73 podium presentations during the 2001 and 2002 meetings, respectively, did not improve interreviewer agreement. Of the papers of the 2002 meeting that ultimately ranked in the top 20 after the full presentation of the papers, 15 papers originally had been ranked less than 20 in the initial grading. Only one of the top three papers of the meeting originally was ranked in the top three before the meeting.
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Clin. Orthop. Relat. Res. · Jun 2004
Anatomic consideration of nerve supply to the vastus medialis in knee surgery.
A medial approach for exposure of total knee arthroplasty that splits the vastus medialis muscles may damage the distal portion of the muscle. Ten fresh-frozen cadaver knees without deformity and three retrieved knees were used to dissect nerve branches along the femoral nerve distally until they ended in muscle. Two patterns of nerve distribution were observed. ⋯ No nerve branches were found crossing between the vastus intermedius and vastus medialis. These muscles appear to be innervated separately by direct branches from the femoral nerve. Dissecting between the vastus intermedius and medialis is unlikely to damage the nerve supply to the vastus medialis obliquus whereas dissecting between the vastus medialis obliquus and main body of the vastus medialis may damage the nerve supply of both.