Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Dec 2009
Can rhBMP-2 containing collagen sponges enhance bone repair in ovariectomized rats?: a preliminary study.
With an aging population the frequency of postmenopausal fractures is increasing. Methods to enhance the repair of osteoporotic bone repair therefore become more important to reduce the society burden of care. We asked if absorbable collagen sponges containing recombinant human bone morphogenetic protein-2 (rhBMP-2) have the potential to enhance bone repair. ⋯ The specimens failed under higher loads in the rhBMP-2-applied groups and histology revealed a higher fracture healing score, including callus formation, bone union, marrow changes, and cortex remodeling. We observed no adverse tissue responses such as fibrous connective tissue formation and inflammatory cellular infiltration. rhBMP-2 in absorbable collagen sponges enhanced bone repair in segmental tibial defects of ovariectomized rats. The sponges with rhBMP-2 appeared to enhance bone repair.
-
Clin. Orthop. Relat. Res. · Dec 2009
Review Meta AnalysisProphylaxis of heterotopic ossification of the hip: systematic review and meta-analysis.
Heterotopic ossification (HO) is a potentially severe, if infrequent, complication in hip surgery, and uncertainty exists regarding whether to use NSAIDs or radiation in its prevention. Thus, we systematically reviewed the literature in MedLine, EMBASE, CINAHL, and the Cochrane Controlled Trial Register and, after ruling out publication bias and data heterogeneity, performed a meta-analysis of randomized, controlled trials to assess effectiveness and complications of NSAIDs and radiation in the prevention of HO. We identified nine studies reporting on effectiveness and complications including a total of 1295 patients. ⋯ There was no association with gender, age, length of followup, or year of publication. The risk ratio for associated complications was 0.79 (95% confidence interval, 0.45-1.41), and, again, was independent of the aforementioned factors. We found no evidence for a statistically significant or clinically important difference between NSAIDs or radiation in preventing HO.
-
Clin. Orthop. Relat. Res. · Dec 2009
Multicenter StudyThe synergistic effect of autograft and BMP-7 in the treatment of atrophic nonunions.
Combining autologous bone graft and recombinant human bone morphogenetic protein-7 (BMP-7) to treat long-bone fracture aseptic atrophic nonunions theoretically could promote bone healing at higher rates than each of these grafting agents separately. We retrospectively reviewed prospectively collected data on patient general characteristics, clinical outcomes, and complications over 3 years to determine the healing rates and the incidence of complications and adverse events of this "graft expansion rationale." There were 45 patients (32 male) with a median age of 43 years (range, 19-76 years). Minimum followup was 12 months (mean, 24.5 months; range, 12-65 months). There were seven humeral, 19 femoral, and 19 tibial nonunions. The median number of prior operations was two (range, 1-7). All fractures united. Clinical and radiographic union occurred within a median of 5 months (range, 3-14 months) and 6 months (range, 4-16 months), respectively. Thirty-nine (87%) patients returned to their preinjury occupation at a mean of 4.2 months (range, 3-6 months). The median visual analog scale pain score was 0.9 (range, 0-2.8; maximum 10), and the median functional score was 86 (range, 67-95; maximum 100) at the final followup. BMP-7 as a bone-stimulating agent combined with conventional autograft resulted in a nonunion healing rate of 100% in these 45 patients. ⋯ Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · Dec 2009
The use of confidence intervals in reporting orthopaedic research findings.
Conflict between clinical importance and statistical significance is an important problem in medical research. Although clinical importance is best described by asking for the effect size or how much, statistical significance can only suggest whether there is any difference. One way to combine statistical significance and effect sizes is to report confidence intervals. ⋯ The use of confidence intervals was independent of impact factor, year of publication, and significance of outcomes. The probability of statistically significant results to predict at least a 10% between-group difference was only 69% (95% confidence interval, 55%-83%), suggesting that a high proportion of statistically significant results do not reflect large treatment effects. Confidence intervals could help avoid such erroneous interpretation by showing the effect size explicitly.