Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 2010
Changes in the number of resident publications after inception of the 80-hour work week.
Since the inception of resident work-hour regulations, there has been considerable concern regarding the influence of decreased work hours on graduate medical education. In particular, it is unclear whether implementation of work-hour restrictions has influenced resident academic performance as defined by quantity of peer-reviewed publications while participating in graduate medical education. ⋯ Since implementation of work-hour changes, total resident publications and publications per resident-year have increased.
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Clin. Orthop. Relat. Res. · Aug 2010
A two-stage retention débridement protocol for acute periprosthetic joint infections.
Due to the historically poor infection control rates with débridement and component retention for acute periprosthetic infections we developed a new approach for treating acute periprosthetic total joint infections: initial débridement with prosthesis retention and placement of antibiotic-impregnated cement beads followed by a second débridement within 7 days, at which time the beads are removed and new modular parts inserted. Intravenous antibiotics were used for 6 weeks followed by oral antibiotics. Depending on the clinical situation, antibiotics are discontinued or in selected patients continued indefinitely. ⋯ Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
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Clin. Orthop. Relat. Res. · Aug 2010
Randomized Controlled TrialThe efficacy of periarticular multimodal drug infiltration in total hip arthroplasty.
Patient-controlled analgesia is a widely used and effective method of controlling pain after THA. This method is associated with substantial undesirable side effects. Local infiltration has been introduced in an attempt to reduce opioid requirements postoperatively, but its ability to reduce pain without complications is still questioned. ⋯ Level I, therapeutic study. See the guidelines online for a complete description of level of evidence.
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Clin. Orthop. Relat. Res. · Aug 2010
Laboratory indicators for early detection and surgical treatment of vibrio necrotizing fasciitis.
Vibrio necrotizing fasciitis is a rare and life-threatening soft tissue infection, with fulminant clinical courses and high mortality rates. However, the lack of specific disease characteristics and diagnostic tools during the initial examination may delay diagnosis. ⋯ Level III Prognostic study. See the Guidelines for Authors for complete descriptions of levels of evidence.
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Clin. Orthop. Relat. Res. · Aug 2010
Immunologic adverse reaction associated with low-carbide metal-on-metal bearings in total hip arthroplasty.
An increased incidence of periprosthetic osteolysis, resulting in loss of biologic fixation, has been reported in contemporary THAs with low-carbide metal-on-metal compared with metal-on-polyethylene couple bearings. Although a hypersensitivity reaction attributable to Co and Cr debris is reportedly a potential cause for failure of THAs with high-carbide bearings, there are no evidence-based data for this reaction in low-carbide metal-on-metal bearings, although such hypersensitivity might be related to osteolysis. ⋯ The conventional histologic and immunohistochemical findings in tissues retrieved from failed THAs with low-carbide metal-on-metal bearings are consistent with a link between hypersensitivity and osteolysis with low-carbide bearing couples.