Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jan 2009
Comparative StudyNo difference in gender-specific hip replacement outcomes.
Gender-specific total hip arthroplasty (THA) design has been recently debated with manufacturers launching gender-based designs. The purpose of this study was to investigate the survivorship and clinical outcomes of a large primary THA cohort specifically assessing differences between genders in clinical outcomes, implant survivorship, revisions as well as sizing and offset differences. We reviewed 3461 consecutive patients receiving 4114 primary THAs (1924 women, 1537 men) between 1980 and 2004 with a minimum of 2 years followup (mean, 11.33 +/- 6.5 years). A subset of patients with complete implant data was reviewed for sizing and offset differences. Preoperative, latest, and change in clinical outcome scores as well as Kaplan-Meier analysis were performed. Men had higher raw clinical outcome scores preoperatively and postoperatively. Differences in change of clinical outcome scores were found only in the WOMAC pain score in favor of the female cohort (39.4 versus 36.1). Survivorship and revision rate were not significantly different. Men used larger stems with greater stem lengths, neck offset, and neck lengths. Current implant systems were sufficiently versatile to address the different size and offset needs of male and female patients. These data suggest there is no apparent need for a gender-designed THA system. ⋯ Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jan 2009
Comment LetterLetter to the editor re: Orthopaedic surgeons prefer to participate in expertise-based randomized trials: Bednarska E, Bryant D, Devereaux, PJ. Orthopaedic surgeons prefer to participate in expertise-based randomized trials. Clin Orthop Relat Res. 2008;466:1734-1744.
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Clin. Orthop. Relat. Res. · Jan 2009
Multicenter StudyDigital image enhancement improves diagnosis of nondisplaced proximal femur fractures.
Today most emergency room radiographs are computerized, making digital image enhancement a natural advancement to improve fracture diagnosis. We compared the diagnosis of nondisplaced proximal femur fractures using four different image enhancement methods using standard DICOM (Digital Imaging and Communications in Medicine) after window-leveling optimization. Twenty-nine orthopaedic residents and specialists reviewed 28 pelvic images consisting of 25 occult proximal femur fractures and three images with no fracture, using four different image filters and the original DICOM image. For intertrochanteric fractures, the Retinex filter outperforms the other filters and the original image with a correct fracture type diagnosis rate of 50.6%. The Retinex filter also performs well for diagnosis of other fracture types. The Retinex filter had an interobserver agreement index of 53.5%, higher than the other filters. Sensitivity of fracture diagnosis increased to 85.2% when the Retinex filter was combined with the standard DICOM image. Correct fracture type diagnosis per minute for the Retinex filter was 1.43, outperforming the other filters. The Retinex filter may become a valuable tool in clinical settings for diagnosing fractures. ⋯ Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jan 2009
Biography Historical ArticleObituary: Charles O. Townley, MD, 1916-2006.