Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 2013
Meta Analysis Comparative StudyIs cervical disc arthroplasty superior to fusion for treatment of symptomatic cervical disc disease? A meta-analysis.
As the current standard treatment for symptomatic cervical disc disease, anterior cervical decompression and fusion may result in progressive degeneration or disease of the adjacent segments. Cervical disc arthroplasty was theoretically designed to be an ideal substitute for fusion by preserving motion at the operative level and delaying adjacent level degeneration. However, it remains unclear whether arthroplasty achieves that aim. ⋯ For treating symptomatic cervical disc disease, cervical disc arthroplasty appears to provide better function, a lower incidence of reoperation related to index surgery at 1 to 5 years, and lower major complication rates compared with fusion. However, cervical disc arthroplasty did not reduce the reoperation rate attributable to adjacent segment degeneration than fusion. Further, it is unclear whether these differences in subsequent surgery including arthroplasty revisions will persist beyond 5 years.
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Clin. Orthop. Relat. Res. · Jun 2013
Meta Analysis Comparative StudyPercutaneous release, open surgery, or corticosteroid injection, which is the best treatment method for trigger digits?
Percutaneous A1 pulley release surgery for trigger digit (finger or thumb) has gained popularity in recent decades. Although many studies have reported the failure rate and complications of percutaneous release for trigger digit, the best treatment for trigger digit remains unclear. ⋯ The frequencies of treatment failure and complications were no different between percutaneous release surgery and open surgery for trigger digit in adults. Patients treated with percutaneous releases were less likely to have treatment failure than patients treated with corticosteroid injections.
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Clin. Orthop. Relat. Res. · Jun 2013
Randomized Controlled Trial Comparative StudyIs pain after TKA better with periarticular injection or intrathecal morphine?
Postoperative pain after TKA is a major concern to patients. The best technique to control pain is still controversial. Intrathecal morphine or periarticular multimodal drug injection are both commonly used and both appear to provide better pain control than placebo, but it is unclear whether one or the other provides better pain control. ⋯ The two techniques provide no different pain control capacity. The periarticular multimodal drug injection was associated with lower rates of vomiting and pruritus.
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Clin. Orthop. Relat. Res. · Jun 2013
Comparative StudyOrthopaedic surgeons frequently underestimate the cost of orthopaedic implants.
A poor understanding of cost among healthcare providers may contribute to high healthcare expenditures. Currently, it is unclear whether and how much surgeons know about the costs of implantable medical devices (IMDs). ⋯ We found the knowledge of orthopaedic IMD costs among the orthopaedic residents and attending surgeons surveyed was poor. Further investigation of how physicians conceptualize material costs will be important to healthcare cost control.
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Clin. Orthop. Relat. Res. · Jun 2013
Comparative StudyTotal knee arthroplasty in the elderly: does age affect pain, function or complications?
TKA is one of the most commonly performed procedures in the elderly, yet whether age influences postoperative pain, function, and complication rates is not fully understood for this group. This is because the current literature has limited followup, small sample sizes, and no comparator group. ⋯ When compared with younger patients, octogenarians can expect comparable pain relief and KSS but lower function and more complications.