Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jan 2014
Comparative StudyPlain radiographs underestimate the asymmetry of the posterior condylar offset of the knee compared with MRI.
Restoration of posterior condylar offset (PCO) during total knee arthroplasty is essential to maximize range of motion, prevent impingement, and minimize flexion instability. Previously, PCO was determined with lateral radiographs, which could not distinguish the asymmetries between the femoral condyles. MRI can independently measure both medial and lateral PCO. ⋯ Plain radiographs underestimate PCO as well as the asymmetry of the medial and lateral PCO compared with MRI. This discrepancy is the result of both articular cartilage thickness and the anatomic differences between medial and lateral condyles. Designers of knee prostheses and instrumentation should take these differences into account.
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Clin. Orthop. Relat. Res. · Jan 2014
Targeted use of vancomycin as perioperative prophylaxis reduces periprosthetic joint infection in revision TKA.
The role of vancomycin in surgical antimicrobial prophylaxis and high-risk patients who are most likely to benefit remains unclear. ⋯ Targeted use of vancomycin in patients undergoing revision TKA was effective in reducing the rate of PJI and PJI resulting from methicillin-resistant organisms in an institution with a high baseline rate of PJI due to MRSA and MRSE. Identification of high-risk subgroups of patients within a surgical population can help target infection prevention strategies to those who are most likely to benefit and thus minimize potential risks (eg, selection of resistant organisms, adverse drug events) associated with broader application of such an intervention.
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Clin. Orthop. Relat. Res. · Jan 2014
Preliminary results suggest tranexamic acid is safe and effective in arthroplasty patients with severe comorbidities.
Tranexamic acid (TXA) reduces blood loss and transfusion after total joint arthroplasty (TJA) but concerns remain that patients with severe medical comorbidities might be at increased risk for thromboembolic complications. ⋯ Although TXA seemed safe and effective in this database review of patients with severe medical comorbidities, a larger prospective trial is warranted to confirm these results.
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Clin. Orthop. Relat. Res. · Jan 2014
Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction.
Understanding the type and magnitude of services that patients receive postdischarge and the financial impact of readmissions is crucial to assessing the feasibility of accepting bundled payments. ⋯ Episode-of-care payments for TJAs vary widely depending on the type of procedure, patient comorbidities and complications, discharge disposition, and readmission rates. Postdischarge care accounted for more than one-third of total episode payments and varied substantially across patients and procedures.
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Clin. Orthop. Relat. Res. · Jan 2014
Does research participation make a difference in residency training?
The American Board of Orthopaedic Surgery requirements state that an orthopaedic residency must offer at least 5 years of clinical education and some exposure to research. To expose residents to basic research, some programs, including ours, have a research track that allows for 1 year of basic science research. The degree to which research productivity during residency-which may be something that can perhaps be influenced by interventions like research tracks during residency-affects residency graduates' future research contributions is unknown. ⋯ Residents who publish in a peer-reviewed journal during residency are more likely to continue publishing in their future careers as orthopaedic surgeons. Future studies are needed to elucidate the causative factors in the association between publishing in a peer-reviewed journal during training and further contributions later in an orthopaedic surgeon's career.