Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 2012
ReviewValue-based care in the management of spinal disorders: a systematic review of cost-utility analysis.
Spinal disorders are a major cause of disability and compromise in health-related quality of life. The direct and indirect costs of treating spinal disorders are estimated at more than $100 billion per year. With limited resources, the cost-utility of interventions is important for allocating resources. ⋯ The literature on cost-utility for treating spinal disorders is limited. Studies addressing cost-utility of nonoperative and operative management of low back pain encompass a broad spectrum of diagnoses and direct comparison of treatments based on cost-utility thresholds for comparative effectiveness is limited by diversity among disorders and methods to assess cost-utility. Future research will benefit from uniform methods and comparison of treatments in cohorts with well-defined pathology.
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Clin. Orthop. Relat. Res. · Apr 2012
Randomized Controlled TrialCan a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty?
Several reports have confirmed the ability of intraoperative periarticular injections to control pain after THA. However, these studies used differing combinations of analgesic agents and the contribution of each, including the local anesthetic agent, is uncertain. Understanding the independent effects of the various agents could assist in improved pain management after surgery. ⋯ Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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The process of clinical decision-making and the patient-physician relationship continue to evolve. Increasing patient involvement in clinical decision-making is embodied in the concept of "shared decision-making" (SDM), in which the patient and physician share responsibility in the clinical decision-making process. Various patients' decision aid tools have been developed to enhance this process. ⋯ In clinical practice today, patients are increasingly involved in clinical decision-making. Further research on SDM in orthopaedic surgery examining the feasibility and impact on practice, on patients' willingness and ability to actively participate in shared decision-making, and the timing and type of patients' decision aids appropriate for use is still needed.
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Clin. Orthop. Relat. Res. · Apr 2012
Is selective arthroscopic revision beneficial for treating recurrent anterior shoulder instability?
Surgeons have traditionally treated recurrent shoulder dislocation by open methods. With the advent of arthroscopic repair techniques some surgeons reported higher recurrence rates than with open methods but some of those reports included patients with a variety of problems, including bone loss and those continuing in contact sports. It is unclear whether recurrence rates would be higher in patients without bone loss and those willing to forego contact sports. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Apr 2012
The natural history of idiopathic frozen shoulder: a 2- to 27-year followup study.
The natural history of spontaneous idiopathic frozen shoulder is controversial. Many studies claim that complete resolution is not inevitable. Based on the 40-year clinical experience of the senior author, we believed most patients with idiopathic frozen shoulder might have a higher rate of resolution than earlier thought. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.